Integrated primary care for post-stroke patients to improve long-term outcomes through multidisciplinary collaboration

Stroke continues to be a leading cause of long-term disability worldwide, necessitating a coordinated approach that extends beyond the acute care phase. Recent insights underscore the value of multidisciplinary collaboration in primary care settings, in which stroke specialists, primary care providers, and allied health professionals work together to manage complex post-stroke needs. This integrated approach not only addresses prevention of recurrent stroke through tighter control of risk factors such as hypertension, diabetes, and cardiovascular disease, but also fosters improved functional recovery, psychosocial support, and holistic health monitoring. Trust-based professional relationships within care teams are pivotal: open communication, shared decision-making, and mutual respect among team members create an environment that encourages patient engagement and adherence to long-term management plans. By aligning clinical expertise with patient education and community resources, these collaborative models can significantly enhance quality of life for stroke survivors. In this Research Topic, we examine how such integration strategies influence patient outcomes, reduce healthcare fragmentation, and pave the way for more sustainable and patient-centered stroke management pathways.

The primary goal of this Research Topic is to explore how integrated primary care approaches, facilitated by multidisciplinary teams, can substantially improve long-term health outcomes and reduce the likelihood of stroke recurrence. By highlighting research on collaborative care frameworks that align stroke specialists, primary care providers, and community-based support services, we aim to illuminate strategies that promote risk factor modification, streamline care coordination, and optimize patient adherence. We also seek to examine how trust-based professional relationships—built on clear communication and shared decision-making—catalyze patient empowerment and sustained engagement in post-stroke management. Ultimately, our objective is to showcase evidence-based insights that will drive more holistic, accessible, and equitable care models for stroke survivors.

We invite manuscripts that delve into the development, implementation, and assessment of multidisciplinary primary care models tailored to post-stroke management. Submissions may address various facets of integrated care, including:
• Evaluation of team-based strategies aimed at reducing recurrent stroke and enhancing overall health outcomes.
• Analysis of coordinated systems that connect stroke specialists, primary care providers, and community resources for improved risk factor control and functional recovery.
• Exploration of how trust-based professional relationships foster patient adherence and satisfaction in diverse healthcare contexts.

We welcome a broad range of article types, such as original research, reviews, systematic reviews, meta-analyses, clinical trials, case studies, policy briefs, and perspectives. Contributions should offer insights into best practices, barriers, and innovations for advancing integrated post-stroke care in both high-resource and underserved settings.