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Koordinierte Schlaganfallnachsorge durch Case Management auf der Basis eines standardisierten Behandlungspfades

Ergebnisse einer monozentrischen Pilotstudie

Organized Post-Stroke Care through Case Management on the Basis of a Standardized Treatment Pathway

Results of a Single-Centre Pilot Study

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Zusammenfassung

Hintergrund

Schlaganfallnachsorgeprogramme auf Grundlage eines durch Case Management gestützten standardisierten Behandlungspfades sollen die Schlaganfallrezidive verhindern und Risikofaktoren minimieren.

Fragestellung

Wir untersuchten die Durchführbarkeit eines standardisierten Behandlungspfades und dessen Effekte auf Risikofaktoren, Lebensstilmodifikation und Adhärenz gegenüber der medikamentösen Sekundärprophylaxe.

Methoden

Von 12/2011 bis 07/2014 schlossen wir konsekutive Schlaganfallpatienten in eine prospektive Pilotstudie ein. Das zwölfmonatige Nachsorgeprogramm umfasste regelmäßige persönliche und telefonische Kontakte durch einen zertifizierten Case Manager. Therapieziele für vaskuläre Risikofaktoren wurden gemäß Schlaganfallleitlinien definiert und kontrolliert. Bei Abweichungen vom Behandlungspfad wurde vom Case Manager interveniert. Eine Abschlussvisite mit Kontrolle der Therapieziele und Erfassung eines Schlaganfallrezidivs erfolgte nach zwölf Monaten.

Ergebnisse

Es wurden 101 Patienten eingeschlossen (57,4 % männlich, medianes Alter 72 [IQR, 62–80] Jahre, medianer NIHSS 2(IQR, 1–5) , 79,2 % ischämischer, 3 % hämorrhagischer Schlaganfall, 17,8 % TIA). Sechsundachtzig (85,1 %) Patienten beendeten den Behandlungspfad vollständig, zwölf (11,9 %) traten zurück, drei verstarben an einer malignen Erkrankung. Es wurden 628 persönliche (6,2/Patient) und 2683 telefonische (26,6/Patient) Kontakte durchgeführt; 379 spezifische Interventionen waren notwendig, hauptsächlich wegen fehlender Medikation und sozialer Belange. Nach zwölf Monaten waren Therapieziele für Blutdruck, Body-Mass-Index, Nikotingebrauch und Cholesterin häufiger (p < 0,05) erreicht als bei Projektbeginn. Es kam zu keinem Schlaganfallrezidiv.

Diskussion

Unser Pilotprojekt zeigt, dass koordinierte Schlaganfallnachsorge mithilfe eines standardisierten Behandlungspfades durchführbar ist und zur effektiven Sekundärprävention beitragen kann.

Abstract

Background

Post-stroke care programs based on a standardized treatment pathway supported by case management may prevent secondary stroke and minimize risk factors.

Objectives

We aimed to determine the feasibility of a standardized treatment pathway and its impact on risk factor control, life-style changes and adherence to secondary prevention medication.

Methods

We conducted a prospective pilot study in consecutive stroke patients. The 12-month post-stroke care program included regular perosnal and phone contact with a certified case manager. Target values for vascular risk factors following current recommendations of stroke guidelines were monitored and treated if necessary. In the case of deviations from the treatment pathway the case manager intervened. Patients were screened for recurrent stroke at the end of the program after 12 months.

Results

We enrolled 101 patients: 57.4 % were male, the median age was 72 (IQR, 62–80) years, median baseline NIHSS score was 2(IQR, 1–5), 79.2 % had an ischemic stroke, 3 % a hemorrhagic stroke, and 17.8 % a transient ischemic attack (TIA). Eighty-six (85.1 %) patients completed the program, 12 (11.9 %) withdrew from the program and 3 died of malignant diseases. In total, 628 personal (6.2/patient) and 2,683 phone contacts (26.6/patient) were conducted by the case manager. Three hundred-seventy-nine specific interventions were necessary mostly because of missing medication, non-compliance, and social needs. After 12 months, target goals for blood pressure, body mass index, nicotine use, and cholesterol were more frequently (p < 0.05) achieved than at baseline. No recurrent stroke occurred during the program.

Conclusions

Our pilot data demonstrate that case management-based post-stroke care is feasible and may contribute to effective secondary prevention of stroke.

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Danksagung

Das Projekt wurde durch Mittel des Europäischen Sozialfonds (ESF) gefördert.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland

    J. Barlinn M.Sc., K. Barlinn, U. Helbig, T. Siepmann, L.-P. Pallesen, H. Urban, V. Pütz, H. Reichmann & U. Bodechtel

  2. Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland

    J. Barlinn M.Sc. & J. Schmitt

  3. Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK

    T. Siepmann

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  1. J. Barlinn M.Sc.
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Correspondence to J. Barlinn M.Sc..

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Interessenkonflikt

J. Barlinn, K. Barlinn, U. Helbig, T. Siepmann, L.-P. Pallesen, H. Urban, V. Pütz, J. Schmitt, H. Reichmann und U. Bodechtel geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Barlinn, J., Barlinn, K., Helbig, U. et al. Koordinierte Schlaganfallnachsorge durch Case Management auf der Basis eines standardisierten Behandlungspfades. Nervenarzt 87, 860–869 (2016). https://doi.org/10.1007/s00115-016-0100-6

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