Five years "Healthy Lower Rhine ... Against Stroke": implementation of a regional, intersectoral and sustainable public health program

Abstract

Aim: Stroke is one of the leading causes of death worldwide. Optimizing health care according to the "time is brain" concept is recommended by the Local Health Conferences (KGK) in North Rhine-Westphalia. In 2001, KGK managers from six neighboring districts and municipalities founded the "Healthy Lower Rhine Network." In 2003 the network launched the program "Healthy Lower Rhine ... Against Stroke." This initiative aims primarily at reducing pre-hospital time, i.e., delays from onset of symptoms to hospital presentation in order to optimize modern acute health care. Improving community knowledge of stroke is crucial in this context as well as training in the professional sector. Methods: The conceptual framework comprised three elements: (1) needs assessment, using local expert panels, surveys into community knowledge and clinic data samples of health care quality; (2) intervention plan containing a social marketing concept with two-level organization and standards, training and education in health care; (3) formative and summative evaluation. Central elements of the intervention plan are: local health targets, collaboration and networking, intersectorality, continuity and sustainability (5-year runtime), corporate design, target groups and settings. Results: The central elements of the concepts were implemented. Community surveys revealed similar deficits in public knowledge on stroke in the city of Düsseldorf (2000 and 2004) and in the Wesel district (2002 and 2008). Knowledge of proper action (phone 112 in case of a stroke) significantly improved in Düsseldorf's community with 32.5% correct statements in 2000 versus 50.6% correct answers in 2004 and, finally, 69% correct answers in 2008 in the Wesel district. Clinics in the Wesel district collected 3-month samples of data on pre-hospital times in 2003 before the start of the initiative and in 2005. There was no significant change, with a constant portion of 28% of patients being hospitalized within a 3-h window after onset of stroke symptoms. Conclusion: Due to medical progress and demographic changes, stroke remains a paramount issue in Public Health in Germany. The "Healthy Lower Rhine Network" uses its program "Healthy Lower Rhine ... Against Stroke" to present a strategy to launch and implement a complex, sustainable and intersectoral Public Health intervention, in spite of a growing shortage of resources in public health services.