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Public Awareness of Stroke Improves Care

A big campaign leads to better, faster treatment

TUESDAY, Oct. 14, 2003 (HealthDayNews) -- A common saying about stroke is that "time is brain," meaning the faster treatment begins after the start of a stroke, the better the chances of survival and recovery.

Researchers now report that a community-wide educational campaign directed toward lay people and their physicians can greatly improve the recognition and acute treatment of stroke.

"If we take an aggressive approach to delivering acute stroke care in this country, we can really have a powerful impact," says study leader Dr. Lewis Morgenstern, an associate professor of neurology at the University of Michigan.

In the Oct. 13 issue of the Archives of Internal Medicine, Morgenstern and his colleagues report on the success of a community-based educational program in improving acute stroke care.

In five rural counties in Texas, the research team tested an educational campaign that used public service announcements, news articles, brochures, billboards and public training to make people aware of stroke symptoms and understand the benefit of rapid treatment. Patients were also encouraged to call 911 to get medical attention.

The public campaign also emphasized the importance of recognizing stroke symptoms and asking for acute stroke therapies in the emergency room.

The researchers also directed a campaign toward physicians. The program included developing protocols for treating stroke and hands-on practice in treating mock strokes.

During the time the campaign was in force, there was a dramatic increase in the number of stroke patients receiving the clot-busting drug, called tissue plasminogen activator (tPA). "Right now the only available approved therapy for acute stroke treatment is tPA," Morgenstern says.

The increase in the number of patients receiving acute stroke care continued to grow. In the six months after the end of the program, about 11 percent of the stroke patients received tPA compared to only about 1 percent of stroke patients in five other counties that had no educational campaign.

"Patients came in having seen or heard the public service announcements or news stories, and pushed the doctors to consider tPA," Morgenstern notes. "Then, seeing the drug's effects, doctors who may have been hesitant to use it became advocates themselves. The community education was the impetus to get the ball rolling."

For tPA to be effective, it must be given within three hours after the onset of stroke, Morgenstern says. He adds that even when newer stroke treatments become available, their effectiveness will be limited by time.

While the program was effective among physicians, there was only a little change in the time it took for people to call for emergency help after the onset of a stroke. The median time from the onset of a stroke to receiving treatment remained far over three hours, according to the report.

"People having a stroke tend to sit around and wait for it to go away. That's the bad thing to do. The good thing to do is to get help right away, because that's when the therapy is effective," Morgenstern says.

He adds there are 720,000 strokes in the United States each year. Strokes are the number one cause of disability and the third leading cause of death.

"Everybody in your community needs to recognize that when someone is having a stroke they should call 911 and get to the hospital fast, and likewise, doctors and nurses have a responsibility to be aware of the latest therapies and give them to patients," Morgenstern stresses.

Dr. David Katz, an associate clinical professor of public health at Yale University, notes the study points out a basic truth: "You can't render care to people who don't seek care." Regardless of the condition, it is critical that people seek care in a timely manner, he adds.

"People should come in seeking medical care with certain expectations," Katz says. "Believe it or not, asking for treatment influences whether or not you get it."

If community members and paramedics know about appropriate therapy, and if doctors and nurses are reminded about appropriate therapy protocols -- as happens in a community education campaign -- there is a good chance that patients will receive appropriate treatment, he explains.

"Empower everyone," Katz says. "Then we have universal knowledge of what optimal therapy is and we increase the chance that patients will get it."

More information

To learn more about stroke, visit the American Stroke Association or the National Institute of Neurological Disorders and Stroke.

SOURCES: Lewis Morgenstern, M.D., associate professor, neurology, University of Michigan, Ann Arbor; David Katz, M.D., M.P.H., associate clinical professor, public health, Yale University, New Haven, Conn.; Oct. 13, 2003, Archives of Internal Medicine
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