Skip to main content
The success of Alberta's Cardiovascular Health and Stroke Strategic Clinical Network (SCN) is testament to the value of integrated systems of care.[1] Recently, Calgary-based Scottish-born stroke neurologist Dr Shelagh Coutts penned a call to action for the Scottish stroke system, noting the lag in adoption of acute stroke care pathways in this publicly funded system compared to its Canadian provincial counterparts.[2] This is despite apparent natural advantages for Scotland like smaller land area (one-eighth that of Alberta with a more concentrated population) and generally less inclement weather, which should allow for easier transport strategies and shorter transport times to acute care. This goes to show that concerted regional efforts like the SCN and the broader national efforts of the Canadian Stroke Network (CSN) are not to be taken for granted; they embody a commitment to excellence in team-delivered care that rise above the challenges of our geography. Indeed, this has real-world benefits for our patients - work by the CSN has shown that the implementation of integrated systems of stroke care were associated with a sustained decline in 30-day mortality in provinces like Alberta compared to provinces that (at the time) did not have such systems.[3] Such data have motivated our counterparts in the United States - who practice within an especially fragmented system - to also advocate for more concerted efforts, for example with respect to pre-hospital emergency transport protocols.[4]
It is also encouraging to see the SCN make a commitment to improving care optimize not only our acute care protocols - in which we have made major strides - but also our post-acute care pathways. In Canada, one area of enduring challenge is access to services like rehabilitation or psychology, as well as secondary prevention medications, particularly for patients with financial barriers.[5] Helping our patients overcome such barriers will be important to further optimize outcomes in these diseases.
References
1. McIntosh CJ, Valaire S, Norris CM. Cardiovascular Health and Stroke Strategic Clinical Network - Healthy hearts and brains for all Albertans. CMAJ 2019;191(Suppl):S15-S16.
2. Coutts S. Preventing unnecessary disability after stroke in Scotland. Lancet 2019;394(10205):1225-1226.
3. Ganesh A, Lindsay P, Fang J, et al. Integrated systems of stroke care and reduction in 30-day mortality: A retrospective analysis. Neurology 2016;86(10):898-904.
4. Fletcher JJ, Majersik JJ. Stroke systems of care: The sum is greater than the parts. Neurology 2016;86(10):886-887.
5. Ganesh A, King-Shier K, Manns BJ, Hill MD, Campbell DJ. Money is brain: financial barriers and consequences for Canadian stroke patients. Can J Neurol Sci 2017;44(2):146-151.