Izazovi makroregionalnog povezivanja zdravstvenih ustanova u cilju bolje dostupnosti i kvalitete zbrinjavanja bolesnika s akutnim moždanim udarom
The Challenges of Macroregional Linking of Health Care Institutions with the Aim of Achieving a Higher Level of Availability and Quality of Care for Patients Suffering from Acute Ishemic Stroke

Summary/Abstract: Pursuant to the Health Protection Act, every person is entitled to health protection including social, collective and individual measures, services and activities aimed at health preserving and improvement, prevention against and early discovery of diseases, as well as timely treatment and care. The health protection of the population of the Republic of Croatia is carried out upon the principles of comprehensiveness, continuity, availability and integral to primary health protection. Health protection conducted by specialists, groups of specialists and hospitals demands a specialised approach. Cerebrovascular diseases take the second place on the top ten list of the most frequent causes of death in Croatia, and the first place among the disability causes. In compliance with the principles of evidence based medicine, emergency care providing for patients suffering from acute ischemic stroke presents a challenge for the health care system demanding a multidisciplinary approach and good cooperation of all engaged in it. For the patients, however, the difference between the good and the bad organisation of emergency care providing may represent the difference between functional independence and various disability grades. With the aim of planning the introduction of a new therapeutic method of thrombolysis, we conducted a pilot study on 100 persons in 2008, and on 169 persons in 2009. The time between the onset of symptoms ili symptom onset and the hospital admission of persons suffering from acute ischemic stroke as well as the percentage of patients who might (according to the criterion of time) be submitted to intravenous thrombolysis, was analysed. The results showed that in 2008, 36 % of such patients were admitted to hospital within the aimed timeframe, while in 2009, this figure came to 39.64 %. The reasons lie in advanced age, lower level of education, longer distance between the place of residence and the hospital, insufficient understanding of the disease symptoms, and the fact that in the analysed period, thrombolytic therapy for treating ischemic stroke was not available at our hospital. The analysis of the distance between the marginal county towns and the county hospital imposes – at the national level – the need for establishing a network of stroke units, which network will not correspond with the administrative county borders; this would ensure that efficient treatment methods become equally available for everybody everywhere.

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