Article

OBJECTIVES: To explore the perspectives of healthcare professionals and
commissioners working with a stroke Early Supported Discharge service in relation
to: (1) the factors that facilitate or impede the implementation of the service,
and (2) the impact of the service. DESIGN: Cross-sectional qualitative study
using semi-structured interviews. Data were analysed by two researchers using a
thematic analysis approach. SETTING: Two Early Supported Discharge services in
Nottinghamshire. PARTICIPANTS: Purposive sampling identified 35 key informants
including practitioners, managers and commissioners. RESULTS: The identified
facilitators to the implementation of evidence-based services were: (1) the
adaptability of the intervention to the healthcare context, (2) the role of
rehabilitation assistants and (3) cross-service working arrangements. Perceived
challenges included: (1) lack of clarity regarding the referral decision making
process, (2) delays in securing social care input and (3) lack of appropriate
follow-on services in the region. Most respondents perceived the impact of the
services to be: (1) reducing in-hospital stay, (2) aiding the seamless transfer
of care from hospital to the community and (3) providing intensive stroke
specific therapy. Commissioners called for greater evidence of service impact and
clarity regarding where it fits into the stroke pathway. CONCLUSIONS: Early
Supported Discharge services were perceived as successful in providing
home-based, stroke specific rehabilitation. Teams would benefit from capitalising
on identified facilitators and developing strategies to address the challenges.
The remit and impact of the services should be clear and demonstrable, with teams
strengthening links with other health and social care providers.

Langue : ANGLAIS