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 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.
Smeeton
Nigel C
NC
King's College London, Division of Health and Social Care Research, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK. nigel.smeeton@kcl.ac.uk
Corbin
David O C
DO
Hennis
Anselm J
AJ
Hambleton
Ian R
IR
Fraser
Henry S
HS
Wolfe
Charles D A
CD
Heuschmann
Peter U
PU
D000368:Aged; D000369:Aged, 80 and over; D001460:Barbados / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D000071939:Stroke Rehabilitation