In May 2000, the Treasurer of Ontario announced an investment of $30 million a year for a comprehensive stroke strategy to be phased in over four years. In June 2000 the Ministry of Health and Long-Term Care (MOHLTC) released Towards an Integrated Stroke Strategy for OntarioÑIt is a joint report by the ministry and Heart & Stroke Foundation of Ontario’s Stroke Strategy Working Group.
Across Ontario, the Ontario Stroke Strategy has made a significant impact. Stroke is being successfully treated. More people are coming to emergency within three hours and stroke teams are using clot busters (tPA) and the new ‘corkscrew like’ mechanical device (the Merci Retriever) to remove the blockages that cause the brain ischemia and disability. Reverend Jim Lee acknowledges, “I suffered a major brain stem stroke in January 2006, at age 50, which caused total right side paralysis. However,” he added, ” I experienced a medical miracle through quick intervention and the use of the clot busting drug, tPA. I am still left with some big challenges associated with some cognitive deficits but my recovery has been quite remarkable.”
Even people who are not admitted to hospital within three hours of ischemic stroke or have hemorrhagic strokes are benefiting from coordinated stroke care. Dedicated multidisciplinary stroke units in acute care and rehabilitation significantly reduce disability and save money. Better imaging techniques now show conclusively rehabilitation assisted recovery is real and significant. A Blueprint for Stroke Rehabilitation: The Canadian Stroke Network’s Improving Outcomes and Maximizing Efficiencies shows that using best practice leads to better recovery for patients, greater efficiencies in the use of the healthcare system and the need for fewer stroke patients to seek institutional care.
Hospital stroke treatment has been so successful that cardiologist, Dr. Beth Abramson says “Canadians have this cozy misperception… that you can be hospitalized, treated and return home good as new.”
Dr. Abramson is right. There are still gaps in the stroke care system. Prevention, primary care, and community reintegration need attention.
We have a shortage of family doctors to manage the chronic conditions that preclude stroke; diabetes, high blood pressure and atrial fibrillation. Better prevention is needed. Dr. Antoine Hakim of the Canadian Stroke Network says that 80% of strokes can be prevented if we utilize the knowledge that we have. …Canadians are not aware of the dangers of high blood pressure or need to monitor their blood sugar carefully. Dr. Nancy Mayo of McGill University and colleagues at McGill have found that stroke survivors do very well in rehabilitation, only to lose what they gained within 6 months because there are few community supports.
“There is no funding for community-based resources,” Dr. Mayo states in the Canadian Stroke Network newsletter. “We have an illness model of health care, once you are no longer in the illness ‘payment envelope’ you’re no longer a priority.” A key finding of the Canadian Best Practice Recommendations for Stroke Care 2006 is that people need follow-up and community reintegration to support recovery and to prevent depression.
Across Ontario, small stroke organizations are working with regional stroke strategy committees to improve care after discharge. Reverend Jim Lee and his wife Debra, a nurse at the Ottawa Hospital, are very aware of the need for support post discharge. “My recovery is wonderful, but I still have challenges, it is nice to know I am not struggling alone,” Jim says.
The Stroke Survivors Association of Ottawa (SSAO) is one of the small organizations across Ontario and Canada that is working to provide community supports for stroke survivors. Sharon Anderson of the SSAO says, “One of the biggest problems identified by professionals working in the community, stroke survivors and caregivers is the lack of current research and information for people after they leave hospital. Chronic disease management models tell us that we need to engage people to manage their own health.”
The Ontario Stroke Strategy is making a difference, but, there is more that can be done. Right now there is no ribbon or wrist band to advocate for stroke. Stroke needs more visibility to ensure that people know what hospitals and rehabilitation can do and what they can do to help themselves.
The association is sponsoring its second stroke recovery conference (www.strokeconference.ca) in August to highlight how they are working together to take stroke recovery to the next level.