Forty-seven patients and 21 carers were recruited to the study. The average age of patients at the time of stroke was 72 years. Patients were, on average, 7–8 months post stroke at the time of assessment. Of the original 16 members of staff recruited to the study, 12 completed at least one assessment. Four were unable to carry out an assessment due to time constraints. Patients waited, on average, 37 days from recruitment to assessment; six patients waited more than 100 days.
Analysis of care plans
For each of the 47 patients assessed, a 16-item care plan had been completed. This included all problem areas except carer social/emotional needs. An ‘other’ section was included on the care plan. A total of 201 problems had been identified (an average of four stroke-related problems per patient) and an associated 175 actions recorded. The most commonly identified problems were in the areas of mobility/falls and personal hygiene (). The largest discrepancies between problems identified and responses recorded occurred in the problem areas of pain (67% response) and cognition (33% response).
Number of patient problems identified and actioned.
Nineteen carers were assessed using an 11-item care plan. Two carers were not present at the time of assessment. In total, 18 carer-specific problems were identified and 15 actions recorded. Carers most commonly reported problems related to mood and social life, patient handling, and falls management (general health [n = 1]; transport [n = 1]; house and home [n = 1]; mobility and falls [n = 5]; personal hygiene [n = 3]; carer emotional/social needs [n = 7].
Survey of unmet needs
The 3-month follow-up survey found that of the 219 patient and carer problems identified at assessment, 54 (25%) problems still existed. The majority of these persisting problems (39/54) had actions recorded against them. Those that did not have a recorded action were twice as likely to persist 3 months after the assessment compared with problems that were acted upon (52 versus 21% of remaining problems). A further 97 new areas of unmet need were also identified but no action was taken regarding these.
Views of participating staff
The questionnaire was completed after 23 assessments. The average time to complete an assessment was 1 hour and 45 minutes (range = 1–4 hours). This was regarded as acceptable, although one staff member did remark that this was only because it was a ‘one-off’.
All responders who completed a questionnaire reported that the time taken to do follow-up work was acceptable. Two people reported that they found the manual difficult to use, mainly due to their unfamiliarity with the document. The reference guides were, in general, regarded as useful, however one person found them difficult to use. In seven assessments, staff members indicated that they were unsure about the adequacy of their skills.
The debriefing sessions provided a more informal forum, enabling staff to discuss their experiences and voice their opinions on the care model. The most prominent observation from the sessions was the attitudinal shift among staff that occurred during the period of study. Initial scepticism regarding the added value of the model over existing assessments was replaced with a general appreciation of the need for a systematic approach to the long-term management of patients who had had a stroke.
As anticipated, there was a general tendency for professional background to influence the approach to delivering the model. Not all staff members worked outside their usual skill base and in feedback sessions there was debate over the different approaches that could have been taken to specific problems. All staff members acknowledged specific gaps in their skill base and appreciated the training provided. The general perception among them was that patients and carers valued their assessments.
An additional development to the model was the construction of a patient and carer checklist. This was given to the patients and carers before, or at, their appointment. Staff members, patients, and carers all found this useful.
Patient and carer interviews
Seven patient/carer qualitative interviews were conducted. The patients were, on average, 7–8 months post-stroke at the time of assessment. The main view expressed was that the assessments had been of limited value and the interviews were used as an opportunity for the patients and carers to expound on ongoing problems. Patients had varying expectations about how the service might have helped them; three reported that they had expected more from the service in terms of providing reassurance and aiding coping, while a fourth patient envisaged little benefit.
The general consensus among the limited number of patients and carers interviewed was that the assessment might have been more beneficial had it been conducted sooner after discharge from hospital. The need for more contact and continuity was an issue.
One assessment question, on sexual problems, had been embarrassing to two patients. In addition, there was evidence from three interviews that advice and information provided by the assessor for particular problems had not been utilised by the patient or carer, such that these problems had not been resolved. No reason was given for their rejection of the advice.
Three patients stated that they had appreciated having someone to visit who showed interest in their problems. One found the contact helpful in a ‘supportive way’, while another described satisfaction associated with information provision, benefits advice, and support in liaising with the GP.