Abstract
Background and Purpose: The Japanese government emphasizes the importance of long-term community care for stroke patients by acute hospitals (AH), convalescent rehabilitation units (CRU), general practices (GP), sanatorium type wards (STW), long-term care facilities (LTCF) and in-home and commuting care services (IHCCS). We conducted a nationwide questionnaire survey to assess the current role of GP in stroke care. Subjects and Methods: Twelve representative prefectures were selected based on the population density. Questionnaires concerning the facility status, community-based referral system, long-term care insurance (LTCI) system and their appropriate indicators were sent to 3,709 GP. Results: 21% of these GP answered. 58% attended stroke patients. 11% had 17±5 (mean±SD) inpatient beds, and stroke patients used 7±6 of these beds. 81±96 post-stroke patients out of 622±521 attending patients were treated by each GP per month. 32±66 post-stroke patients were found to be dependent. 57% engaged in-home care for dependent individuals, and 37% undertook post-stroke rehabilitation. Only 5% answered that their post-stroke rehabilitation was adequate. A simple independence scale for LTCI was mainly used to assess ADL. AH (68%) were expected to play a central role in the community-based referral system. Good or fair relationships with AH, CRU, other GP, STW/LTCF/IHCCS, the general community and the local authority were found in 68%, 47%, 45%, 58%, 59% and 31%, respectively. Medical/care information sharing was achieved in 11%/10% and not scheduled in 57%/60%. Many problems in the cooperation system with medical insurance and LTCI were evident. The proper assessment indicator for GP by a third party was the measurement of the cooperation with AH (68%). Conclusions: GP recognized that the post-stroke rehabilitation was inadequate. At present, the information sharing for stroke patients remains unsatisfactory.
