Falling through the net of stroke care.

Full Abstract

The provision of healthcare services has been shown to differ by social characteristics such as gender, age and social status. The processes by which such differences arise are unclear. We report findings from a qualitative interview study with stroke service providers undertaken during an investigation of inequalities in stroke care. We interviewed 41 professionals from hospital and community settings in south London. Participants' accounts are used to explore how it is that patients' trajectories of care might not follow evidence-based guidelines, focusing on stroke unit admission, provision of hospital rehabilitation therapies and community health and social services. Categories of patients who might not receive best care were people who were cognitively impaired, those regarded as having 'complex problems', those with communication problems and younger people. Additionally, the local availability of services was thought to affect individuals' chances of receiving particular components of care. Although professionals spoke of certain types of patients as 'falling through the net' (of services), their accounts suggest that they channel patients through services according to an implicit template of the individual suited to the service. Those who do not fit the service as currently resourced may have reduced access to specific components of care. If inequalities in access to care are to be addressed we require a better understanding of how professionals' decision-making processes test the fit between service users and the implicit template of 'suitable' patient or client.

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Author information

Author/s: Mold, Freda (F); Wolfe, Charles (C); McKevitt, Christopher (C);

Affiliation: Division of Health & Social Care Research, King's College London, UK.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Health & social care in the community (Health Soc Care Community), published in England. (Language: eng)

Reference: 2006-Jul; vol 14 (issue 4) : pp 349-56

Dates: Created 2006/06/21; Completed 2006/08/08; Revised 2007/11/15;

PMID: 16787486, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Community Health Services - organization & administration
Health Services Accessibility - organization & administration
Hospital Administration
Humans

Humans
Qualitative Research
Quality of Health Care - organization & administration
Stroke - rehabilitation

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