Stroke patients’ pathways to rehabilitation in Portugal

PURPOSE: To report on stroke patients’ pathways to rehabilitation in Portugal, in light of an ongoing EHSD procedure. THEORY AND METHODS: The Portuguese government has created the National Network of Continuous Integrated Care (RNCCI) to reduce costly acute care and length of stay in hospitals by substituting less costly care closer to the community. The network is based on establishing protocols with existing institutions, designated according to the kind of services they provide as convalescence, medium-term and rehabilitation, long-term and maintenance, palliative care unit and day care and autonomy promotion units. Home care is supposed to be one important element in this network, but implementation only now is starting. Integration outside the RNCCI and between the RNCCI and other levels of care is still low, especially between health and social institutions and between formal and informal care. The study is based on an RCT encompassing patients admitted to a stroke unit. Those fulfilling admission criteria are randomised to the intervention group or the control group. In the control group patients receive traditional care. In the intervention group patients receive EHSD services. All are followed for 6 months after discharge. Data are collected regarding outcomes and patients’ pathways. RESULTS: Preliminary results confirm the existence of a very fragmented and complex setting. CONCLUSIONS AND DISCUSSION: Beside the benefit that might accrue to patients receiving home rehabilitation, the simple fact of having someone assisting them navigate the system play a significant role in patient and family motivation, satisfaction and quality of life.