Stroke remains a leading cause of death and long-term disability in the United States, with a substantial share of cases preventable. Secondary stroke prevention focuses on controlling modifiable risk factors and consistent use of antiplatelet or anticoagulant therapy. A prior stroke is a strong predictor of a future one, making the period after an initial event critical for intervention.
Social Determinants Widen Stroke Disparities
However, not everyone has equal access to this critical window. Social determinants of health create disparities in stroke incidence, care, and outcomes. Underserved and rural populations face barriers like limited access to rehabilitation, uncontrolled hypertension, and structural obstacles such as transportation and insurance limitations.
The Challenges of Post-Stroke Care for Underserved Populations
In a recent NeuroVoices discussion, Eva Mistry, MD, a stroke expert and professor of neurology at the University of Cincinnati, highlighted the specific challenges faced by underserved patients after a stroke. These challenges include resource limitations, access to rehabilitation, and medication adherence.
Dr. Mistry emphasized that underserved populations often struggle to access facilities best suited for stroke recovery. Underinsured individuals may face restrictions on rehabilitation services, impacting their ability to achieve full recovery. Additionally, access to essential medications, such as antiplatelet therapies and blood pressure control drugs, can be challenging, leading to suboptimal management of secondary stroke prevention.
Recurrent strokes significantly increase disability, morbidity, and mortality. Each stroke exponentially reduces the chances of recovery, placing a greater burden on caregivers and society. Families of underserved patients often face increased caregiving responsibilities, exacerbating socioeconomic strain.
Telehealth and Holistic Care Offer Solutions
The clinical community is becoming more aware of social determinants of health, leading to improved care practices. Clinicians are now more likely to prescribe medications covered by insurance and connect patients with resources before discharge. Telehealth has emerged as a valuable tool, particularly for rural patients, providing access to neurology specialists and timely decision-making.
A Holistic Approach to Stroke Prevention
Dr. Mistry advises clinicians to view patients holistically, addressing all risk factors contributing to stroke. Hypertension control, for instance, is a critical factor in both primary and secondary stroke prevention. Clinicians should also involve family members in patient education, especially when cognitive challenges hinder a patient’s ability to manage their health.
Disparities persist in the neurology community despite overall improvements in stroke incidence. Dr. Mistry stresses the importance of ensuring equitable care and leaving no one behind. While progress has been made, particularly in telehealth, there is still much work to be done to address the complex barriers faced by underserved populations.
The expansion of telehealth into outpatient settings has been a significant step forward, addressing some access to care disparities, particularly for patients in rural areas. However, challenges like medication access and rehabilitation services require continued attention. By focusing on full care and social determinants of health, the neurology community can work toward reducing disparities and improving outcomes for all stroke patients.
Dr. Mistry advocates for a multi-faceted approach to secondary stroke prevention, one that considers not just medical treatments but also the broader social and economic factors influencing health.
Post-Stroke Challenges for Underserved Populations
For underserved populations, the post-stroke period is fraught with challenges extending beyond medical treatment. Transportation barriers, insurance limitations, and limited access to specialists create a cycle of disadvantage increasing the risk of recurrent strokes. Addressing these issues requires both clinical solutions and systemic changes to ensure all patients have access to necessary care.
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One practical example of progress is the use of telehealth in acute stroke care. By connecting rural hospitals with neurology specialists, telehealth ensures timely and effective treatment, addressing some access to care disparities. However, this is just one piece of the puzzle. Long-term management of risk factors, such as hypertension and diabetes, remains challenging for patients with limited access to medications and follow-up care.
Clinicians play a critical role in breaking down these barriers. By taking a holistic approach, they can address immediate medical needs and underlying social and economic factors contributing to stroke risk. This includes educating patients and their families, prescribing affordable medications, and connecting patients with community resources.
The neurology community increasingly recognizes these issues, but sustained effort is needed. As Dr. Mistry notes, the burden of stroke disproportionately affects underserved populations, and addressing this disparity requires a commitment to equitable care. By raising awareness and implementing practical solutions, clinicians and policymakers can reduce stroke’s impact on all populations.
The goal is clear: ensure every patient, regardless of background, has access to the care needed to prevent a second stroke. This requires a collaborative effort across healthcare, from clinicians and hospitals to insurers and community organizations. Together, a future can be created where stroke prevention is truly equitable and effective for everyone.
University of Cincinnati Leads Advocacy Efforts
The University of Cincinnati remains a leader in this effort, with Dr. Mistry and colleagues at the forefront of research and advocacy. Their work shows the importance of addressing social determinants of health in stroke prevention and highlights the need for ongoing innovation and collaboration. Their insights will be invaluable in shaping a more equitable approach to stroke care.
Clinicians can bridge gaps in care by advocating for patients and connecting them with resources. This may involve working with pharmaceutical assistance programs for affordable medications or partnering with community organizations for transportation assistance. By actively addressing barriers, clinicians ensure patients receive the care needed to prevent recurrent strokes.
Hypertension control is a key challenge in stroke prevention. As Dr. Mistry notes, even moderate improvements in hypertension control can significantly impact stroke prevention. This requires not just prescribing medication but also patient education and support. Clinicians can help by simplifying treatment regimens, providing clear instructions, and involving family members in care.
Rehabilitation is another critical aspect of stroke prevention. Access to rehabilitation services is often limited for underserved populations, particularly in rural areas. Clinicians can advocate for patients and connect them with community-based programs offering physical therapy, occupational therapy, and other supportive services.
Family members play a vital role in stroke prevention and recovery. By involving them in the care process and providing support and resources, clinicians can reduce the burden of caregiving and improve outcomes for both patients and families.
Addressing social determinants of health is essential to reducing disparities in stroke prevention. This includes improving access to healthy foods, promoting physical activity, and addressing housing instability and food insecurity. By working with community organizations and policymakers, clinicians can create a healthier environment for patients and reduce stroke risk at the population level.