Our Stroke ICP Programme aims to coordinate and integrate care for stroke patients across the care continuum. Conditions of stroke patients who are enrolled in the programme will be managed in a holistic approach by our multi-disciplinary team, which includes a neurologist, neurosurgeon, case manager, neurology specialty nurse, physiotherapist, occupational therapist, speech therapist, pharmacist, psychologist, medical social worker and dietitian.
Our programme provides primary care physicians and stroke patients with easy access to expert advice as well as an easy point of contact via our case manager.
Under our Stroke ICP Programme, a case manager will:
- Monitor and assess the progress of stroke patients who have been discharged from the hospital at periodic intervals
- Monitor patients' adherence to evidence-based therapy
- Provide patient education to patients and caregivers
- Provide step-down care and end-of-life care resources to patients and caregivers
This collaborative partnership between our rehab physician, Jurong Community Hospital and primary care physicians in the community can bring about better care as well as coordination of care for stroke patients in the west.
