Abstract
BackgroundOutpatient medical follow-up post-stroke is not only crucial for secondary prevention but is also associated with a reduced risk of rehospitalization. However, being voluntary and non-urgent, it is potentially determined by both healthcare needs and the socio-demographic context of stroke survivor-caregiver dyads. Therefore, we aimed to examine the role of caregiver factors in outpatient medical follow-up (primary care (PC) and specialist outpatient care (SOC)) post-stroke.MethodStroke survivors and caregivers from the Singapore Stroke Study, a prospective, yearlong, observational study, contributed to the study sample. Participants were interviewed 3-monthly for data collection. Counts of PC and SOC visits were extracted from the National Claims Database. Poisson modelling was used to explore the association of caregiver (and patient) factors with PC/SOC visits over 0–3 months (early) and 4–12 months (late) post-stroke.ResultsFor the current analysis, 256 stroke survivors and caregivers were included. While caregiver-reported memory problems of a stroke survivor (IRR: 0.954; 95% CI: 0.919, 0.990) and caregiver burden (IRR: 0.976; 95% CI: 0.959, 0.993) were significantly associated with lower early post-stroke PC visits, co-residing caregiver (IRR: 1.576; 95% CI: 1.040, 2.389) and negative care management strategies (IRR: 1.033; 95% CI: 1.005, 1.061) were significantly associated with higher late post-stroke SOC visits.ConclusionWe demonstrated that the association of caregiver factors with outpatient medical follow-up varied by the type of service (i.e., PC versus SOC) and temporally. Our results support family-centred care provision by family physicians viewing caregivers not only as facilitators of care in the community but also as active members of the care team and as clients requiring care and regular assessments.
Highlights
Outpatient medical follow-up post-stroke is crucial for secondary prevention but is asso‐ ciated with a reduced risk of rehospitalization
While caregiver-reported memory problems of a stroke survivor (IRR: 0.954; 95% confidence intervals (CI): 0.919, 0.990) and caregiver burden (IRR: 0.976; 95% CI: 0.959, 0.993) were significantly associated with lower early post-stroke primary care (PC) visits, co-residing caregiver (IRR: 1.576; 95% CI: 1.040, 2.389) and negative care management strategies (IRR: 1.033; 95% CI: 1.005, 1.061) were significantly associated with higher late post-stroke specialist outpatient care (SOC) visits
We demonstrated that the association of caregiver factors with outpatient medical follow-up varied by the type of service (i.e., PC versus SOC) and temporally
Summary
Outpatient medical follow-up post-stroke is crucial for secondary prevention but is asso‐ ciated with a reduced risk of rehospitalization. Being voluntary and non-urgent, it is potentially determined by both healthcare needs and the socio-demographic context of stroke survivor-caregiver dyads. We aimed to examine the role of caregiver factors in outpatient medical follow-up (primary care (PC) and specialist outpatient care (SOC)) post-stroke. While the acute phase includes emergency care in a tertiary inpatient setting, the sub-acute or early chronic phase comprises rehabilitation and outpatient medical follow-up to ensure continuity of care and implement secondary prevention practices. Researchers in a study reported family physicians (93.2%) to be the most frequently visited healthcare professional post-stroke, followed by other medical specialists (54%) [5]. Being voluntary and non-urgent, outpatient medical follow-up in PC or specialist outpatient care (SOC) setting is potentially determined by both healthcare needs and overall socio-demographic context of caregivers and stroke survivors. Evidence suggests that caregivers’ involvement in care plans of their care recipients and providing adequate education to the caregivers can decrease costs and increase patient satisfaction [7]
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