Patient, carer and health worker perspectives of stroke care in New Zealand: a mixed methods survey

Purpose: It is important to understand how consumers (person with stroke/family member/carer) and health workers perceive stroke care services. Materials and methods: Consumers and health workers from across New Zealand were surveyed on perceptions of stroke care, access barriers, and views on service centralisation. Quantitative data were summarised using descriptive statistics whilst thematic analysis was used for free-text answers. Results: Of 149 consumers and 79 health workers invited to complete a survey, 53 consumers (36.5%) and 41 health workers (51.8%) responded. Overall, 40/46 (87%) consumers rated stroke care as ‘good/excellent’ compared to 24/41 (58.6%) health workers. Approximately 72% of consumers preferred to transfer to a specialised hospital. We identified three major themes related to perceptions of stroke care: 1) ‘variability in care by stage of treatment’; 2) ‘impact of communication by health workers on care experience’; and 3) ‘inadequate post-acute services for younger patients’. Four access barrier themes were identified: 1) ‘geographic inequities’; 2) ‘knowing what is available’; 3) ‘knowledge about stroke and available services’; and 4) ‘healthcare system factors’. Conclusions: Perceptions of stroke care differed between consumers and health workers, highlighting the importance of involving both in service co-design. Improving communication, post-hospital follow-up, and geographic equity are key areas for improvement.Implications for rehabilitation Provision of detailed information on stroke recovery and available services in the community is recommended. Improvements in the delivery of post-hospital stroke care are required to optimise stroke care, with options including routine phone follow up appointments and wider development of early supported discharge services. Stroke rehabilitation services should continue to be delivered ‘close to home’ to allow community integration. Telehealth is a likely enabler to allow specialist urban clinicians to support non-urban clinicians, as well as increasing the availability and access of community rehabilitation.