Running Header: Case Study 2 – Stroke Cases in Canada

Case Study #2
Angela Arambula
October 28, 2016
HCM-530 Community Health Evaluation/Epidemiology
Professor Bal
Saint Leo University
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Abstract:

The Queen’s Health Policy Research Unit has a need for services for patients who have

experienced a stroke. There are currently 177,500 individuals in need of intervention services.

These individuals have experienced a stroke due to different risk factors such as,

hypercholesterolemia, hypertension, diabetes and obesity to name a few. Some of these

interventions include CT scans, MRI and vessel imaging. The following assesses the need for

stroke services in Ontario, Canada.

Keywords: Stroke, risk factors, interventions, hypercholesterolemia, CT scan, MRI, imaging

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A stroke is the result of an interruption in the flow of blood to the brain. There are many

risk factors that account for stroke cases. Some risk factors include heavy alcohol consumption,

diabetes, hypertension, obesity, low physical activity, smoking, high cholesterol, and different

types of heart conditions. According to the CDC, these risk factors can increase a person’s

chance of having a stroke. Stroke kills approximately 130,000 individuals each year. Risks vary

by ethnicity, age and geographical location. CDC 2015 The QHPRU (Queen’s Health Policy

Research Unit got their estimates for most of these conditions from the Canadian Heart Health

Survey and the Ontario Health Survey.

For each risk factor, there are several interventions that would be effective. The QHPRU

has listed the proportion of people whom these interventions would be effective. When

considering hypercholesterolemia, a fasting lipo-protein analysis is suggested for 95% of all at-

risk patients that indicate all the risk factors. For individuals that show high LDL cholesterol

levels and present at least one cardiovascular risk factor a non-pharmacological dietary

intervention is recommended for 75% of at-risk individuals. A pharmacological intervention is

recommended for 25% of individuals that present high LDL levels where dietary measures over

a 3-6-month period has failed to lower lipid levels.

When discussing interventions for acute and chronic stroke victims there are several

interventions to consider. Individuals who are acute stroke survivors are recommended several

interventions. Carotid endarterectomy is recommended for 5% of at risk individuals that have

indicted a need for intervention. 10% of at risk individuals are recommended thrombolytic

therapy. Non-invasive imaging of the brain is recommended for 98% of at risk individuals,

considering that MRI’s and cerebral angiography’s are recommended for only 09% and 8% of at

risk individuals. Rehabilitation is recommended for 50% of the surviving acute stroke cases.
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There is an estimate of 177,500 individuals in Eastern Ontario with

hypercholesterolemia. The ages of the 177,500 is broken down into ages groups. There are

30,000 men and 13,000 women ages 25-44. 33,000 men and 42,500 women ages 45-64 and

17,000 men and 42,000 women ages 65 and older. 95% of these individuals require a lipoprotein

analysis. That is 168,625 of individuals. 75% of these individuals required a dietary intervention,

that is 133,125 of individuals. Out of these individuals that required interventions for

hypercholesterolemia. 25% required pharmacological interventions. That is 44,375 individuals.

Currently 66,000 patients are provided dietary interventions for hypercholesterolemia. A

pharmacological intervention is provided to roughly 15,500 patients. The estimated needs for

these interventions were 133,125 and 44,375 respectively. The unmet need for the dietary

intervention was 67,125 patients. (133,125 – 66,000 = 67,125) that is 50% of patients needs who

were not met. (67,125/133,125 x100 = 50.42%) The unmet need for pharmacological

intervention was 28,875 patients. (44,325 – 15,500 = 28,875) that is 65% of patients whose

needs were not met. (28,375/44,375 % 100 = 65%)

There were an estimated 3,500 incidences of acute stroke cases reported. 100 patients

died before reaching the hospital. An estimated 340 individuals were not hospitalized and 2,890

that were hospitalized. These patients will benefit from core stroke services such as diagnostic

tests, prevention of recurring stroke and assessing of disability. 289 patients will require

thrombolytic therapy. Brain imaging such as a CT scan will be required by 3,332 patients. An

MRI will be needed by 306 patients. Non-invasive imaging of the vessels will be needed by

3,332 patients and invasive imaging of the vessels will be required by 238 patients. Carotid

endarterectomy will be required by 170 patients. 1,700 of these acute stroke cases needing
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intervention will require rehabilitation. All 4,300 patients with chronic stroke and disability will

require assistance in performing activities of daily living and home care.

There is an estimated need for thrombolytic imaging services for approximately 289

patients and 170 carotid endarterectomy. Eastern Ontario provides thrombolytic imaging to 50

patients, and carotid endarterectomy to 200 patients. The unmet need for thrombolytic therapy

would be 239 patients. (289 – 50 = 239), that is 83% of patients whose needs were not met.

(239/289 x 100 = 83%) The unmet need for carotid endarterectomy would be -30 of patients (170

-200 = -30) that is 18% of patients whose needs were over met. – (30/170 x 100 = 18%)

The estimated need for CT brain imaging is 3,332. The estimated need for MRI imaging

is 306. Non-invasive imaging of vessels is needed for 3,332 and invasive imaging is needed for

238 patients. The unmet need for CT brain imaging would be 2,332. (3,332 – 1,000 = 2,332),

that is 70% of patients (2,332/3,332 x 100 = 70%) The unmet need for MRI imaging would be

156 patients (306 – 150 = 156), that is 51% of patients with unmet needs. (156/306 x 100 = 51%)

The unmet need for non-invasive imaging would be 2,907 patients. (3,332 – 425 = 2,907), that is

87% patients with unmet needs. (2,907/3,332 x 100 = 87%) The unmet need for invasive

imaging would be 68 patients (238 – 170 = 68), that is 29% of patients with unmet needs.

(68/238 x 100 = 29%)

Conclusion. The estimated need for rehabilitation is 1,700 and an estimated need of 4,300 for

patients needing home care. Eastern Ontario provides services to 1,400 acute stroke victims and

1,400 chronic stroke victims. The unmet needs for rehabilitation would be 300 patients. (1,700 -

1,400 = 300), that is 18% of patients with unmet needs (300/1,700 x 100 = 18%) The unmet

needs for home care is 2,900 patients. (4,300 – 1,400 = 2,900) that is 67% of patients with unmet

needs. (2,900/4,300 x 100 = 67%)

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References

CDC, NCHS. (2015) Underlying Cause of Death 1999-2013 Retrieved from: CDC WONDER
Online Database

Fleming. S. (2008) Managerial Epidemiology: Concepts and Cases. Chicago. Health

Administration Press.