A survey of the health care needs in patients after stroke treatment in Son Tay, Ha Noi

Journal of military pharmaco-medicine n o 1-2020 146 A SURVEY OF THE HEALTH CARE NEEDS IN PATIENTS AFTER STROKE TREATMENT IN SON TAY, HANOI Ho Van Thanh1; Nguyen Bien Cuong1; Vu Van Tha1 SUMMARY Objectives: To survey the health care needs in patients after stroke treatment in Son Tay, Hanoi. Subjects and methods: A retrospective, cross-sectional descriptive study of 200 emergency stroke patients who were treated at 105 Military Hospital in Son Tay from 2017 - 2018. Results: The common age was from 60 - 80 (55%) and at the age of 40 - 59 accounted for 26.5% (53/200). The rate of male patients were 60.5% and female 39.5%. After stroke, it left many common sequelae such as dyskinesia (76.5%); sensory disorder (68.5%) and language disorders (63%). The survey revealed that the number of patients who adhered to the re-examination regime, health counseling after stroke was very low. The proportion of patients who did not follow the re-examination after stroke was 67.5%. The incidence of patients who did not call medical staff for health advice accounted for 77.5%. 82% of medical staffs did not call the patients to give advice after they were treated. The percentage of medical staffs did not come to the patients' home for medical examination and counseling accounted for 90.5%. After stroke, the rate of patients with high demand for health care, and caregivers accounted to 52%, re-examination 77.5%, health consultant 66%, treatment 86.5%, labor 51%, participating in social activities 73.5%. Conclusion: It is necessary to do well the taking care for patients after stroke in order to prevent recurrent brain strokes, rehabilitate and help patients to reintegrate into society. * Keywords: Stroke; Health care demand. INTRODUCTION According to the World Health Organization's statistics, stroke is the third cause of death after cardiovascular diseases and cancer, but in the first rank of disability in adults. Annually, in Europe, there is approximately one million patients hospitalized for stroke treatment [1]. In the United States, the proportion of people with stroke are 794/100,000 people, 5% of the US population over 65 years old suffer from stroke [8]. In Japan, the stroke rate is from 340 to 352/100,000 people [3]. In China, the rate of stroke is 219/100,000 people [10]. In Vietnam, according to aggregate data from hospitals which have neurology department, each year there are more than 200,000 people who suffer from stroke, more than 50% of whom die and 90% of the stroke survivors must live with the sequelae [4]. According to statistical report by 105 Military Hospital, annually they receive about 800 stroke patients. More than a half of them need to continue treating, taking care, rehabilitating in the right method. 1. Military Medical College N01 Corresponding author: Ho Van Thanh (hovanthanh1975@gmail.com) Date received: 30/11/2019 Date accepted: 31/12/2019 Journal of military pharmaco-medicine n o 1-2020 147 However, there is no standardized care and rehabilitation system for stroke patients in this area. On the other hand, there have been no reports on demand for health care of patients after stroke treatment. Therefore, we carried out the article: To survey the health care needs of patients after stroke treatment in Son Tay, Hanoi. SUBJECTS AND METHODS 1. Subjects. 200 stroke patients who were treated at 105 Military Hospital from January 2017 to June 2018. They resided in Son Tay, Hanoi after hospital discharge. 2. Methods. * Research design: Retrospective, cross-sectional description study. * Data collecting method: Using questionares to interview the research subjects, collecting the information about anthropology (age, gender, occupation), the information about healthcare need after stroke. * Data processing: Using medical statistical methods, by software SPSS 22.0. RESULTS AND DISCUSSION 1. General features of subjects. Table 1: Anthropological characteristics. Characteristics n Rate (%) p Male 121 60.5 Gender Female 79 39.5 < 0.05 ≤ 40 0 0.0 40 - 59 53 26.5 60 - 79 110 55.0 Age group ≥ 80 37 18.5 < 0.05 The results showed that the proportion of male patients was more than females, this difference was statistically significant with p < 0.05. This result was consistent with some studies by Duong Huu Bac (2018) [1], Nguyen Van Chuong (2015) [3], and Nguyen Ngoc Triu (2014) [9], the proportion of male patients was 60.7%, 61.7% and 60.6%, respectively. This was explained by the risk factors that common cause stroke in men such as hypertension, diabetes, hyperlipidemia... The common age was from 60 - 80, followed by 40 - 59 years old. According to Nguyen Van Chuong, Nguyen Thi Mai Dung and Nguyen Trong Luu, stroke usually occurs at the age above 50, the most common age was 60 - 79 [3, 4, 9], because at this age, the risk factors tend to increase, on the other hand, the protective factors have a declining trend. Journal of military pharmaco-medicine n o 1-2020 148 Table 2: Sequelae of stroke. Ischemic stroke (n = 174) Hemorrhagic strokes (n = 26) Type of stroke Sequelae Number Rate (%) Number Rate (%) Movement disorder 129 74.1 24 92.3 Sensory disorder 115 66.1 23 88.4 Language disorder 105 60.3 21 80.7 Visual disorder 50 28.7 15 57.6 Hearing disorder 51 29.3 12 46.1 Sleeping disorder 84 48.3 22 84.6 Mental disorder 3 1.7 4 15.3 Headache 86 49.4 24 92.3 Dementia 78 44.8 21 80.7 After stroke, patients had many sequelaes; the common sequelae were movement disorder; sensory disorder and language disorder. Life-saving treatment was the first priority, but caring and rehabilitation of sequelae for patients after stroke were also very important [4, 5]. 2. The actual situation of re-examination, counseling and treatment of patients after stroke. Table 3: Characteristics of re-examination, counseling and treatment of patients after stroke. Ever (n = 200) At least once (n = 200) Times Content Number Rate (%) Number Rate (%) The patients re-examined after stroke treatment 135 67.5 65 32.5 The patients called medical staffs for health counseling 155 77.5 45 22.5 The medical staffs called the patients for health counseling 164 82.0 32 18.0 Medical staff visited the patients’ homes for examination, treatment and counseling 181 90.5 19 9.5 The rate of re-examination was low compared to the WHO’s recommendation, patients should be re-examined once a month or at least once every 3 months [10]. Re-examination helped doctors identify the patients’ condition after stroke to have a plan for treating, caring and rehabiliting the sequelae. Journal of military pharmaco-medicine n o 1-2020 149 According to Thrift A.G in the US, the proportion of patients after stroke who called the medical staffs or that medical staffs called the patients or caregivers at least once a month accounted to 86.3%; this ratio in Norway was 91.6% and in France was 77.3% [10]. According to WHO, patients and medical staffs had better contact each other by phone for health advice once a month or at least once every 3 months [10]. According to WHO, there are many ways and methods to take care of patients after stroke, in which the health sector sent out the caring team to the patients’ home was an effective method [2, 10]. However, the actual situation of rehabilitation for patients who were out of hospital in Son Tay town, Hanoi was quite low. It was necessary to increase the taking care of patients after stroke who were out of hospital. Re-examination, counseling and treatment for patients after stroke play an important role in helping patients recover and prevent relapse. 3. The health care needs of patients after stroke. Caregivers: 104 patients (52%); re-examination: 155 patients (77.5%); health counseling: 132 patients (66%); treatment: 173 patients (86.5%); work: 102 patients (51%); social activities: 147 patients (73.5%). This result was somewhat similar to previous studies on the health care needs of patients after stroke [5, 6]. Thus, most people after stroke had the need of re- examination, health advice, treatment and recover from sequelae. Therefore, it was necessary to meet the demands of stroke patients, help patients recover as soon as possible, prevent relapse, defect and return to the community and society. CONCLUSION Through the study of 200 stroke patients who were treated at 105 Military Hospital, resided in Son Tay after discharge, we showed that the common age was from 60 - 80 (55%), followed by 40 - 59 years old (26.5%). The male patient rate was 60.5%, female was 39.5%. After stroke, it left many common sequelaes such as dyskinesia (76.5%); sensory disorder (68.5%), and language disorder (63%). After stroke, the number of patients who adhered to the re-examination regime, health consultation and treatment was quite low. The proportion of patients after stroke did not follow the re-examination regime accounted for 67.5% and 32.5% of patients took the re-examination at least one. 77.5% of patients did not call medical staffs for health advice, at least once 22.5%; medical staffs did not call for patients after stroke to give health advice 82%, at least 1 time 18%; the medical staffs did not visit the patients’ homes to examine and give health advice 90.5%, at least once 9.5%. After stroke, patients had a high demand for health care, 52% of them needed caregivers, re-examination 77.5%, health advice 66%, treatment 86.5%, labor 51%, and participated in social activities 73.5%. It is necessary to do well the care of patients after stroke to prevent the stroke relapse, rehabilitation, help patients re-integrate into society. Journal of military pharmaco-medicine n o 1-2020 150 REFERENCES 1. Duong Huu Bac, Nguyen Ngoc Anh. Evaluating the results of applying nursing procedures for stroke patients in Emergency Department, 108 Military Central Hospital. 108 Clinical Medicine Magazine. 2018, 13, pp.6-8. 2. Mai Hong Bang. Treating and caring for stroke patients at 108 Military Central Hospital. People's Army Publishing House. 2017, pp.10-12. 3. Nguyen Van Chuong. Stroke. People's Army Publishing House. 2015, pp.37. 4. Nguyen Thi Mai Dung, Nguyen Nhu Binh. 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