The state of stroke medicine in ukraine before the reform of specialized care

Abstract

Objective – to study the approaches to providing medical care to patients with acute ischemic stroke in Ukraine before the reform and to identify the necessary changes for further improvement of this care. Materials and methods. The study analyzed the stroke care system in Ukraine. Data collection was carried out through a survey of 408 healthcare institutions, resulting in 532 completed questionnaires. Additionally, a review of regulatory documentation, medical university curricula, and scientific publications was conducted. Results. The survey of 408 healthcar e institutions and the analysis of 532 questionnair es revealed significant disparities in stroke care delivery. A total of 13,965 beds were reported for stroke patients, but these were not confined to dedicated stroke units and included beds in intensive care, neurology, and neurosurgery departments. Only 235 institutions had specialized intensive care units. Workforce analysis showed a sufficient number of neurologists, neurosurgeons, and anesthesiologists; however, the lack of standardized treatment approaches led to inconsistency in care quality. A significant shortage of nursing staff was identified, with one nurse caring for up to 15 patients per shift — far exceeding the recommended staffing norms of European stroke centers (Intercollegiate Stroke Working Party, 2023). Equipment availability also remains a challenge: only 103 MRI and 199 CT scanners were reported across the studied facilities, limiting access to timely diagnosis and modern treatment (Poltava Regional Military Administration, 2023). The availability of thrombolytic therapy remains significantly below European standards, with only 100 clinics reporting experience with its use (European Stroke Organisation, 2021). These findings emphasize the urgent need for investment in infrastructure, human resources, and the implementation of evidence-based clinical str oke treatment protocols. Conclusions. Before the reform of specialized care, patients with acute ischemic stroke in Ukraine received varying levels of treatment depending on infrastructure and staff readiness to implement reperfusion therapy. Gradual implementation of European Stroke Organisation standards and the establishment of a national stroke registry are critical steps toward improving quality control and optimizing str oke care delivery.