A Comparison of Acute and Long-Term Management of Stroke Patients in Barbados and South London

Background: To compare health care utilisation between stroke patients living in a middle-income country with similar patients in a high-income country in terms of the type and amount of health care received following a stroke. Methods: Data were collected from the population-based South London Stro...

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Vydáno v:Cerebrovascular diseases (Basel, Switzerland) Ročník 27; číslo 4; s. 328 - 335
Hlavní autoři: Smeeton, Nigel C., Corbin, David O.C., Hennis, Anselm J., Hambleton, Ian R., Fraser, Henry S., Wolfe, Charles D.A., Heuschmann, Peter U.
Médium: Journal Article
Jazyk:angličtina
Vydáno: Basel, Switzerland S. Karger AG 01.04.2009
Témata:
Aged
Aged, 80 and over
Barbados - epidemiology
Emergency Medical Services - statistics & numerical data
Emergency Medical Services - utilization
Female
Follow-Up Studies
Humans
Logistic Models
London - epidemiology
Long-Term Care - statistics & numerical data
Long-Term Care - utilization
Male
Middle Aged
Original Paper
Prospective Studies
Registries
Risk Factors
Severity of Illness Index
Socioeconomic Factors
Stroke - epidemiology
Stroke - therapy
Stroke Rehabilitation
Stroke, statistics
Stroke, long-term management
Stroke care
Stroke, caregivers
Health services research
Post-stroke rehabilitation
Stroke, acute management
ISSN:1015-9770, 1421-9786, 1421-9786
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Shrnutí:Background: To compare health care utilisation between stroke patients living in a middle-income country with similar patients in a high-income country in terms of the type and amount of health care received following a stroke. Methods: Data were collected from the population-based South London Stroke Register (SLSR) and the Barbados Register of Strokes (BROS) from January 2001 to December 2004. Differences in management and diagnostic procedures used in the acute phase were adjusted for age, sex, ethnic group, living conditions pre-stroke and socio-economic status by multivariable logistic regression. Comparison of subsequent management was made for 3 months and 1 year post-stroke. Results: Patients in BROS were less likely to be admitted to a hospital ward (OR 0.22; 95% CI 0.13–0.37), but the difference for the lower use of brain scans in BROS was smaller (OR 0.62; 95% CI 0.25–1.52). Additional adjustment for stroke severity (Glasgow Coma Score) showed that BROS patients were more likely to have a swallow test on admission (OR 2.95; 95% CI 1.17–7.45). BROS patients were less likely to be in nursing care at 3 months (OR 0.37; 95% CI 0.17–0.81), and less likely to be receiving speech and language therapy at 3 months (OR 0.10; 95% CI 0.03–0.33) and 1 year (OR 0.05; 95% CI 0.00–0.55). Conclusions: The lower use of hospital admission and nursing care at 3 months suggests that in Barbados, family and friends take greater responsibility for patient care around the time of the stroke and in the medium term thereafter.
Bibliografie:ObjectType-Article-2
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ISSN:1015-9770
1421-9786
1421-9786
DOI:10.1159/000202009