Time Window for Acute Stroke Management: A Cross-Sectional Study Among Community Healthcare Practitioners in Primary Care

Abstract

Huajie Yang,1,* Xiang Huang,2,* Chunyu Yang,3 Sufen Zhu,4 Xiaoyi Chen,5 Man Zhang,2 Xiao Yu,3 Harry HX Wang3,6,7 1School of Health Technology, Guangdong Open University (Guangdong Polytechnic Institute), Guangzhou, People’s Republic of China; 2Department of Public Health, Sanxiang Community Health Service Centre of Zhongshan, Zhongshan, People’s Republic of China; 3School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 4Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; 5School of Nursing, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 6Department of General Practice, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China; 7JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region*These authors contributed equally to this workCorrespondence: Harry HX Wang, School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China, Tel [phone], Email [email protected]; [email protected] Huajie Yang, School of Health Technology, Guangdong Open University (Guangdong Polytechnic Institute), Guangzhou, 510091, People’s Republic of China, Tel [phone], Email [email protected]: Time-to-treatment window is critical for managing acute ischaemic stroke. The community healthcare practitioners (CHPs) who deliver frontline care in the health system play an important role in stroke prevention and treatment.Methods: A multi-stage sampling design was adopted in Guangdong province, China. A total of 997 CHPs who participated in the survey were divided into two groups (the awareness group vs the unawareness group) according to their knowledge on the time window for stroke management. Logistic regression analysis was performed to explore factors associated with the awareness of “time window”.Results: Overall, less than half (49.1%) of CHPs were aware of the time window for stroke management. The proportion of CHPs who were able to recognise stroke symptoms were higher in the awareness group (42.7%) than that in the unawareness group (38.8%). Most CHPs (82.9%) in the awareness group had the knowledge about the effectiveness of intravenous thrombolysis in treating acute cerebral infarction, whereas this was perceived by only less than half (43.6%) of CHPs in the unawareness group. Factors associated with the knowledge of time window for stroke management included participation in cerebrovascular disease management training (adjusted odds ratio [aOR]=4.203, 95% CI: 1.707– 10.348, p=0.002), awareness of the time frame for CT initiation (aOR=5.214, 95% CI: 1.803– 15.078, p=0.002) and for urokinase thrombolysis administration (aOR=11.927, 95% CI: 4.393– 32.382, p< 0.001), accurate perceptions about the target for blood pressure lowering (aOR=4.181, 95% CI: 1.713– 10.207, p=0.002) and blood glucose control (aOR=2.446, 95% CI: 1.019– 5.869, p=0.045), and the familiarity with prehospital stroke management principles (aOR=3.593, 95% CI: 1.383– 9.332, p=0.009).Conclusion: The CHPs need to enhance their ability to address the acute ischaemic stroke onset promptly to provide effective treatment within the beneficial “time window”. This may help improve the stroke chain of survival with better multidisciplinary decision support systems that enable optimal stroke care delivery.Keywords: time window, stroke, cross-sectional study, primary care

Keywords

• time window
• stroke
• cross-sectional study
• primary care