Abstract 245: Association Between Levels of Caregiver Engagement and Rates of Self-reported Healthcare Utilization After Stroke: A Mixed Methods Study

Abstract

Background: Caregivers (CGs) are critical in helping stroke survivors retain function and receive adequate healthcare. We aimed to identify the activities that CGs are engaged in over the course of stroke care and explore the association between levels of CG engagement and rates of post-stroke formal healthcare utilization for care recipients (CRs). Methods: We qualitatively analyzed 9-month post-stroke interviews with CRs (n=118; 57.6) and CGs (n=87; 42.4%) about their experience before, during and following the stroke from the Caring for Adults Recovering from the Effects of Stroke (CARES)study. A codebook with data-driven codes was developed using an inductive iterative process and codes were assigned by two coders with 94.9% agreement. We classified CRs as having either engaged or non-engaged CGs based on whether they indicated CG involvement in any part of their stroke care in the interviews. Using Fisher’s exact test, we compared differences between groups in rates of self-reported visits to medical doctors, physical therapists, hearing or speech language pathologists (SLP), home health nurses/aids/personal attendants and mental health professionals, as well as differences in the number of emergency room (ER) visits and hospitalizations. Results: Interviewees most often described CG involvement as driving the CR to the hospital or calling 911 (n=48; 23.4%), requesting additional inpatient care (n=20; 9.8%), coordinating medical appointments (n=43; 21.0%) and monitoring recovery (n=23; 11.2%). CRs with engaged CGs had worse functioning (Stroke Impact Scale [median]=630.0 vs. 689.2; P=0.045), higher rates of audiology or SLP visits (33.3% vs. 22.6%; P=0.033) and more ER visits (mean 2 visits vs.1 visit; P=0.0032) compared to those with non-engaged CGs (Table 1). Conclusions: CRs with engaged CGs had higher rates of healthcare utilization compared to those with non-engaged CGs, suggesting that access to services may be facilitated by the CG. Higher rates of utilization may also be driven by more severe strokes and greater need for healthcare services in this group. Future research should focus on stroke severity as a potential modifier in the relationship between CG engagement and healthcare utilization.