Medina County District Library

Background: Stroke patients have complex needs and are at high risk for complications, making transitional care critical to achieving improved outcomes. Although shared medical appointments (SMAs) are known to improve outcomes for other patient populations, evidence supporting SMA benefit for stroke patient transition from hospital to home is lacking. This study’s purpose was to examine feasibility of participation, patient satisfaction and understanding of key stroke topics following a transitional stroke SMA. Methods: Inclusion criteria for this study included: age 18 years or older, hospitalized for stroke/TIA, and planned discharge to home. Individuals with deficits impairing group participation were excluded. Eligible patients were educated on and invited to attend a SMA occurring 1-2weeks after hospital discharge. The SMA included a private exam and interactive group session to address key stroke topics: 1) medication compliance 2) individual risk factors, 3) secondary prevention, 4) signs of stroke and 5) actions for signs of stroke. Following the SMA, participants completed a two-part survey seeking a) a yes/no response to assess increased understanding of stroke topics, and b) level of agreement on satisfaction with the SMA format. Responses were analyzed using descriptive statistics. Results: While 15 patients agreed to participate prior to discharge, only eight attended the SMA. Attendees were primarily male (75%) with an ischemic stroke diagnosis (63%). The majority who did not attend were female (71%) and without family present during in-hospital education and invitation (86%). Age, stroke severity and stroke risk factors for both groups were otherwise similar. All participants reported an increased understanding of all stroke topics and 95% were satisfied with the SMA. Conclusion: Findings support use of SMAs for stroke patients transitioning from hospital to home. Reinforcing key stroke topics in a peer supported environment may increase understanding and compliance, leading to improved outcomes. Additional research is warranted to explore barriers to SMA participation.

Back to table of contents Previous article Next article Letters to the EditorFull AccessCanadian System WorksJohn L. Kuehn, M.D.John L. KuehnSearch for more papers by this author, M.D.Published Online:20 Mar 2009https://doi.org/10.1176/pn.44.6.0029It was good to see the letter from Nancy Porter-Steele, Ph.D., in the January 2 issue recommending the Canadian health system. I was a colleague and friend of her husband, Curtis Steele, M.D., when we were both practicing in Baton Rouge, La., in the 1960s and 1970s. I always wondered where he'd gone after I left town and we “lost touch.”For many reasons, I have been concerned about the future of private practice for many years and am now a supporter of a single-payer health system by gradually bringing everyone under Medicare (which has cared for me so well since I developed cancer and have had other problems). I finally solved most of my problems with private practice by going into public psychiatry. Dr. Steele went to Canada.Furthermore, I frequently share meals with Canadian physicians at a bed-and-breakfast during annual trips to the Shaw Festival at Niagara-on-the-Lake in Ontario. Although I have not talked to any orthopedic surgeons (waiting lists for hip replacements?), I find that the primary care physicians who stay at the same place are quite satisfied with their practice arrangements and compensation, and as Nancy Steele describes in detail, they particularly like the low overhead and lack of “hassle.” It would be interesting and useful to see letters from others with similar or different experiences in foreign practice in Psychiatric News.Medina, Ohio ISSUES NewArchived

The dissatisfaction of truck drivers associated with issues related to the family is examined. This dissatisfaction is seen as a major reason for high turnover rates in the trucking industry. The nature of commercial vehicle driver work and family environments is more clearly defined through mail survey questions asked of both the driver and their spouse/partner. Specific questions in the survey address work concerns, family concerns, decision making, informational needs, communication, and leisure time. Methods to apply this information to programs of intervention and support useful to commercial vehicle companies are identified. Results indicated that family-related information would help support drivers and their families. In addition, a literature review discusses job characteristics of drivers, describes stressors for the families, and identifies possible coping skills and intervention methods.

Thirty‐two counseling trainees were rated on level of facilitative functioning before and after prepracticum. Evidence is presented that pretraining and early training levels of facilitative functioning are directly related to later performance in practicum.