Increasing Public Recognition and Rapid Response to Stroke

Definitions Public recognition –Improving knowledge of symptoms –Advancing awareness EMS importance Rapid response –Elevate motivation for immediate action

Example of 911 call D: emergency 911 C: my husband has just had another little stroke and I’ve given him some time to recoup from this and… D: Okay, but he has had a stroke? C: I’m not a doctor. I would think so. …..I tried to call the hospital but they told me to call you D: Is he breathing Okay? C: He’s breathing Okay, but he’s far from the norm……he’s so weak….he can answer my questions but he’s not, really not alert. I must say that this happened about an hour ago. I have to tell you that, that it didn’t just happen. Maybe I waited too long, I don’t know.

Mission Statement Promote the rapid presentation of stroke patients to acute therapy hospitals by encouraging improvement in symptom knowledge and recognition, and elevating motivation for seeking immediate acute stroke therapy among patients, caregivers, and the community

Report Outline Nature of the problem Lessons from AMI Nature of the message Role of knowledge and motivation Who’s responsible? Integrating community and health care Costs Measuring success Special population Recommendations

Nature of the Problem Seek medical care? Symptoms begin Call 911? Arrival at hospital Seen by ED physician Receive a CT scan Drug administration Pre-hospital phase In-hospital phase

Median prehospital delay for stroke in study date order Evenson et al. Neuroepidemiol 2001;20:65-76 Median hours

Nature of the Problem Seek medical care? Symptoms begin Call 911? Arrival at hospital Seen by ED physician Receive a CT scan Drug administration Pre-hospital phase In-hospital phase

Lessons AMI experience –Single symptom and action message –Recognized by 90% of adults –Experience from interventions positive Acute Stroke studies –More complex symptom message –Limited experience relative to MI –Encouraging evidence of intervention benefit

Nature of the Message Clear, crisp, tailored, sustainable Essential elements –Stroke symptoms –Immediacy (every second counts) –Call to action (use 911) Examples –Brain Attach Coalition –FAST

Knowledge and Motivation Poor knowledge of stroke symptoms Knowledge alone not sufficient Urgency component also important Motivation to act immediately Social and environmental context Health behavior principles

Who is Responsible? Stakeholders –Patients, families, health professional, insurance companies, government agencies Dual strategies needed –Top down- national organizations –Bottom up- grass roots movements

Who is Responsible (2) Health care providers/facilities –Local education and outreach Costs will be substantial –Support needed from public, private, non- profit organizations

Integration of community and health care providers Intricate communication chain –Health care providers,pharmacists, EMS, allied health, public –Bi-directional Doctors educating patients Knowledgeable patients request best therapy Venues – hospitals, worksites, public schools, doctor’s offices, pharmacies

Costs Cost effectiveness data scarce Costs of sustained public education high Cost of stroke high –Disability and health care costs More data needed

Measuring Success Percent of patients presenting to hospital –Within 3 hours since symptom onset Goal = 70% –Median time Change in knowledge Need better measure of success

Special Populations High risk targets –Example-blacks Tailored interventions –Examples- children Other –Women –Elderly –Rural

Recommendations Education must be multi-level Stroke messages intense and sustained Education must combine knowledge and call to action Target is all citizens Tailored for special populations

Recommendations for Research Efficacy of educational interventions –Cost effectiveness –Sustainability –Outcomes –Reaching special populations Pediatric stroke