Dudley Strategy for Tackling Health Inequalities 2010-15

Establishing the level of health equity involves investigating if differences exist inaccess and treatment/ treatment outcomes based on deprivation, ethnicity, age, sexand occupation. The extent to which this can be achieved easily depends on thelevel of data available especially within routine data sets and also thecoverage/reach of a service or programme. Developments within stroke/TIA arerelatively new - coverage of new service developments are low and data systems arein development or very recently implemented. As a result this section has gaps in itsanalysis and makes recommendations for future audits. Areas reviewed include:admissions for stroke and TIA,timely access to treatment for emergency stroke and TIA,access to timely diagnostics and treatment for urgent and non-urgent strokeand TIA.The pathways for stroke and TIA can be categorised into urgent and non urgent. Forurgent (hyper acute) patients should be admitted to a stroke ward, given theappropriate scans within 1 hour and thrombolysed within 3 hours. Dudley Group ofHospitals introduced a 24/7 thrombolysis service in 2007 to meet this requirement.For non urgent stroke, patients should be admitted to a stroke ward and scannedwithin 24 hours. TIA patients identified as urgent - at high risk of stroke, may or maynot be admitted, but should be scanned and treated within 24 hours. Those at lowrisk should be treated and managed within 7 days. In Dudley, a fast track referralsystem operates within the hospital and throughout primary care to ensure urgentand non urgent cases are treated at the TIA clinic within the necessary time frames.AdmissionsEmergency admissions have been relatively static over the last 5 years for both menand women, while elective admissions have risen, especially for men, although thisis not a statistically significant rise. Men have higher rates of admissions thanwomen overall, which reflects their higher risk of CVD. The admissions data forstroke and TIA shows that at the macro level, admissions generally reflected thehigher risk and needs of specific population groups including men, BME anddeprived groups but that factors other than actual need, strongly influenced accessto treatment once deprivation, sex and age were accounted for.85