Patient dissatisfaction with acute stroke care.
OBJECTIVE
Riks-Stroke, the Swedish Stroke Register, was used to explore patient characteristics and stroke services as determinants of patient dissatisfaction with acute in-hospital care.


METHODS
All 79 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. During 2001 to 2007, 104,876 patients (87% of survivors) responded to a follow-up questionnaire 3 months after acute stroke; this included questions on satisfaction with various aspects of stroke care.


RESULTS
The majority (>90%) were satisfied with acute in-hospital stroke care. Dissatisfaction was closely associated with outcome at 3 months. Patient who were dependent regarding activities of daily living, felt depressed, or had poor self-perceived general health were more likely to be dissatisfied. Dissatisfaction with global acute stroke care was linked to dissatisfaction with other aspects of care, including rehabilitation and support by community services. Patients treated in stroke units were less often dissatisfied than patients in general wards, as were patients who had been treated in a small hospital (vs medium or large hospitals) and patient who had participated in discharge planning. In multivariate analyses, the strongest predictor of dissatisfaction with acute care was poor outcome (dependency regarding activities of daily living, depressed mood, poor self-perceived health).


CONCLUSIONS
Dissatisfaction with in-hospital acute stroke care is part of a more extensive complex comprising poor functional outcome, depressive mood, poor self-perceived general health, and dissatisfaction not only with acute care but also with health care and social services at large. Several aspects of stroke care organization are associated with a lower risk of dissatisfaction.
Riks-Stroke, Department of Medicine, University Hospital, SE-90185 Umeå, Sweden. kjell.asplund@branneriet.se
Kjell
K
Asplund
Fredrik
F
Jonsson
Marie
M
Eriksson
Birgitta
B
Stegmayr
Peter
P
Appelros
Bo
B
Norrving
Andreas
A
Terént
Kerstin Hulter
KH
Asberg
D000203:Activities of Daily Living / Q000523:psychology; D000208:Acute Disease; D000368:Aged; D001294:Attitude to Health; D017281:Cost of Illness; D003863:Depression / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data / Q000639:trends; D006764:Hospitals, Community / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008503:Medical Staff / Q000706:statistics & numerical data / Q000639:trends; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010814:Physical Therapy Department, Hospital / Q000706:statistics & numerical data / Q000639:trends; D011787:Quality of Health Care / Q000706:statistics & numerical data / Q000639:trends*; D012647:Self-Assessment; D012944:Social Support; D012947:Social Work / Q000706:statistics & numerical data / Q000639:trends; D020521:Stroke / Q000451:nursing / Q000628:therapy*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome