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Jewett L, Harroud A, Hill MD, et al. Secondary stroke prevention services in Canada: a cross-sectional survey and geospatial analysis of resources, capacity and geographic access. CMAJ Open. 2018;6(1):E95-E102doi: 10.9778/cmajo.20170130.
Jewett, L., Harroud, A., Hill, M. D., Côté, R., Wein, T., Smith, E. E., Gubitz, G., Demchuk, A. M., Sahlas, D. J., Gladstone, D. J., & Lindsay, M. P. (2018). Secondary stroke prevention services in Canada: a cross-sectional survey and geospatial analysis of resources, capacity and geographic access. CMAJ open, 6(1), E95-E102. https://doi.org/10.9778/cmajo.20170130
Jewett, Lauren, et al. "Secondary stroke prevention services in Canada: a cross-sectional survey and geospatial analysis of resources, capacity and geographic access." CMAJ open vol. 6,1 (2018): E95-E102. doi: https://doi.org/10.9778/cmajo.20170130
Jewett L, Harroud A, Hill MD, Côté R, Wein T, Smith EE, Gubitz G, Demchuk AM, Sahlas DJ, Gladstone DJ, Lindsay MP. Secondary stroke prevention services in Canada: a cross-sectional survey and geospatial analysis of resources, capacity and geographic access. CMAJ Open. 2018 Feb 21;6(1):E95-E102. doi: 10.9778/cmajo.20170130. PMID: 29472251; PMCID: PMC5878947.
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CMAJ Open. 2018 Feb 21;6(1):E95-E102. doi: 10.9778/cmajo.20170130.

Secondary stroke prevention services in Canada: a cross-sectional survey and geospatial analysis of resources, capacity and geographic access.

CMAJ open

Lauren Jewett, Adil Harroud, Michael D Hill, Robert Côté, Theodore Wein, Eric E Smith, Gord Gubitz, Andrew M Demchuk, Demetrios J Sahlas, David J Gladstone, M Patrice Lindsay

Affiliations

  1. Affiliations: Department of Geography and Planning (Jewett), University of Toronto, Toronto, Ont.; Department of Neurology and Neurosurgery (Harroud, Côté, Wein) and Department of Medicine (Harroud, Cote, Wein), McGill University, Montréal, Que.; Calgary Stroke Program (Hill, Smith, Demchuk), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alta; Queen Elizabeth II Health Sciences Centre (Gubitz), Dalhousie University, Halifax, NS; Division of Neurology (Sahlas), Department of Medicine, McMaster University, Hamilton, Ont.; Sunnybrook Health Sciences Centre (Gladstone) and Hurvitz Brain Sciences Research Program (Gladstone), Sunnybrook Research Institute, Department of Medicine, University of Toronto; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.

PMID: 29472251 PMCID: PMC5878947 DOI: 10.9778/cmajo.20170130

Abstract

BACKGROUND: Rapid assessment and management of transient ischemic attacks and nondisabling strokes by specialized stroke prevention services reduces the risk of recurrent stroke and improves outcomes. In Canada, with its vast geography and with 16.8% of the population living in rural areas, access to these services is challenging, and considerable variation in access to care exists. The purpose of this multiphase study was to identify sites across Canada providing stroke prevention services, evaluate resource capacity and determine geographic access for Canadians.

METHODS: We developed a Stroke Prevention Services Resource Inventory that contained 22 questions on the organization and delivery of stroke prevention services and quality monitoring. The inventory ran from November 2015 to January 2016 and was administered online. We conducted a geospatial analysis to estimate access by drive times. Considerations were made for hours of operation and access within and across provincial borders.

RESULTS: A total of 123 stroke prevention sites were identified, of which 119 (96.7%) completed the inventory. Most (95) are designated stroke prevention or rapid assessment clinics. Of the 119 sites, 68 operate full time, and 39 operate less than 2.5 days per week. A total of 87.3% of the Canadian population has access to a stroke prevention service within a 1-hour drive; however, only 69.2% has access to a service that operates 5-7 days a week. Allowing provincial border crossing improves access (< 6-h drive) for those who are beyond a 6-hour drive within their home province (3.4%).

INTERPRETATION: Most Canadians have reasonable geographic access to stroke prevention services. Allowing patients to cross borders improves the existing access for many, particularly some remote communities along the Ontario-Quebec and British Columbia-Alberta borders.

Copyright 2018, Joule Inc. or its licensors.

Conflict of interest statement

Competing interests: See the end of the article.This study was presented in part at the 2016 Canadian Stroke Congress, Sept. 15-17, 2016, Québec, Que.

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