Determinants of access to rehabilitation professionals by individuals with stroke in the first six months after hospital discharge in Brazil: a study based on the Andersen model

Abstract

ABSTRACT Background determinants of accessto rehabilitation professionals after stroke in middle-income countries, wherethe burden of this disease is higher, are little known. Objectives To identify the determinants of accessto rehabilitation professionals by individuals with stroke at one, three, andsix months after hospital discharge in Brazil and compare referral and accessrates after discharge. Methods Longitudinal and prospective study, withindividuals with primary stroke, without previous disabilities. At hospitaldischarge, the number of rehabilitation professionals referred by themultidisciplinary team was recorded. The possible determinants of access,according to Andersen’s model, were: a) predisposing factors: age, sex,education levels, and belief that they could improve with treatment; b) needfactors: stroke severity, levels of disability; c) enabling factors:socioeconomic status, disposable income for health care, and quality of careprovided by rehabilitation professionals. One, three, and six months afterhospital discharge, individuals were contacted to identify which rehabilitationprofessionals were accessed. Multiple linear regression model and Wilcoxon tests were used(α=5%). Results 201 individuals were included.Disability levels and stroke severity explained 31%, 34%, and 39% (p<0.01)of access at one, three, and six months after hospital discharge, respectively.In all periods, there was less access than that recommended at the time ofhospital discharge (p<0.01). Conclusion Need factors (disability levels andstroke severity) were determinants of access in all assessed periods. Inaddition, in all periods, the comprehensiveness of care for individuals withstroke was compromised.