Use of health care services after stroke.
OBJECTIVE
To describe the use of care before and after stroke and to evaluate equity in access to health care services after stroke.


METHODS
Cross sectional study.


METHODS
The Netherlands.


METHODS
382 patients living in the community who had been admitted to hospital with a stroke six months before.


METHODS
Sociodemographic status and functional health status according to The Barthel index, Rankin scale, and sickness impact profile, assessed during interview, and general practitioner (GP) characteristics obtained by postal questionnaire. Univariate and multivariate analyses of the relation between patient and GP related factors and use of care.


RESULTS
Compared with the period before stroke the use of care six months after stroke increased significantly, especially use of physical therapy, home help, and aids. Multivariate analyses showed that impaired functional health increased the use of care (range in odds ratios 1.6 to 6.7). Compared with younger patients, elderly patients were more likely to have home help (odds ratio 2.9) and aids (2.4) but less likely to receive therapy (0.4), psychosocial support (0.5), and an appreciable amount of care (0.5). Being female (1.7), living alone (4.0), and whether the GP was informed about patients' discharge (2.2) increased the use of home help. Higher financial income (2.8) and having a male GP (3.2) contributed to use of therapy. Emotional distress (1.6), living protected (3.2), and living alone (1.7) accounted for psychosocial support.


CONCLUSIONS
Although older age, lower income, and poor discharge information to the GP decreased the use of some types of care, there is equity in access to care after stroke, primarily determined by needs in terms of functional health status and predisposing factors such as living arrangement and social circumstances.


CONCLUSIONS
Patient oriented studies focusing on care processes and care outcomes in terms of subjective needs, perceived care deficits, and satisfaction with care are still required.
Department of Clinical Epidemiology, University of Amsterdam.
R
R
de Haan
M
M
Limburg
J
J
van der Meulen
G A
GA
van den Bos
D000359:Aftercare / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D002561:Cerebrovascular Disorders / Q000534:rehabilitation*; D003625:Data Collection; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D010821:Physicians, Family / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors