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社区中中风幸存者及其非正式照料者的正式支持:一项队列研究。

Formal support of stroke survivors and their informal carers in the community: a cohort study.

作者信息

Simon Chantal, Kumar Satinder, Kendrick Tony

机构信息

Department of Primary Medical Care, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK.

出版信息

Health Soc Care Community. 2008 Dec;16(6):582-92. doi: 10.1111/j.1365-2524.2008.00782.x. Epub 2008 Mar 27.

Abstract

This cohort study, aims to explore formal care provision to stroke survivors and their informal carers in the community in the UK. An initial cohort of 105 cohabitant carers of first-time stroke patients was recruited while the stroke patient was in hospital. Structured face-to-face interviews were carried out with carers prior to discharge of the stroke patient home, at 6 weeks after discharge, and 15 months after stroke. Questionnaires included measures of psychological health (CIS-R), physical health (self-rated health), social well-being (relationship quality and Sarason's social support questionnaire), handicap of the stroke survivor (Oxford Handicap Scale) and formal community support (amount of formal support and carer satisfaction). Multiple services were involved with most survivor-carer pairs (mean 5.4; range 2-9; SD = 1.7), and 74% of carers were satisfied with formal support provided. Number of services decreased with time (5.5 versus 4.1, t = 4.201, d.f. = 52, P < 0.001, 95% confidence interval: 0.71-2.01) but not time allocated. Using stepwise linear regression, service provision early after discharge was predicted by: level of handicap, recruitment centre, carer self-rated health, number of informal supporters and other care commitments. Satisfaction was predicted by quality of informal support and activity restriction. Fifteen months after stroke, predictors of formal care were: level of handicap, quality of informal support and previous caring experience. Predictors of satisfaction were: quality of the relationship between the stroke survivor and carer, age and mood. Quality of services was good, but carers lacked information, had insufficient help and were not consulted enough. Carer distress is common, yet not currently a factor influencing support provision. Formal care provided adapts with time reflecting the importance of quality of support from friends and family rather than quantity of informal supporters. These factors should be taken into consideration when planning and providing formal support for stroke survivors and their carers.

摘要

这项队列研究旨在探索英国社区中为中风幸存者及其非正式照料者提供的正式护理服务。在中风患者住院期间,招募了105名首次中风患者的同居照料者作为初始队列。在中风患者出院前、出院后6周和中风后15个月,对照料者进行了结构化面对面访谈。问卷包括心理健康(CIS - R)、身体健康(自评健康)、社会福祉(关系质量和萨拉森社会支持问卷)、中风幸存者的残疾情况(牛津残疾量表)以及正式社区支持(正式支持的数量和照料者满意度)等测量指标。大多数幸存者 - 照料者对涉及多种服务(平均5.4项;范围2 - 9项;标准差 = 1.7),74%的照料者对所提供的正式支持感到满意。服务数量随时间减少(5.5项对4.1项,t = 4.201,自由度 = 52,P < 0.001,95%置信区间:0.71 - 2.01),但分配的时间没有减少。采用逐步线性回归分析,出院后早期服务提供情况的预测因素为:残疾程度、招募中心、照料者自评健康状况、非正式支持者数量和其他护理任务。满意度的预测因素为非正式支持的质量和活动受限情况。中风后15个月,正式护理的预测因素为:残疾程度、非正式支持的质量和以往照料经验。满意度的预测因素为:中风幸存者与照料者之间关系的质量、年龄和情绪。服务质量良好,但照料者缺乏信息、帮助不足且未得到充分咨询。照料者苦恼很常见,但目前并非影响支持提供的因素。所提供的正式护理会随时间变化,这反映了朋友和家人支持质量而非非正式支持者数量的重要性。在为中风幸存者及其照料者规划和提供正式支持时,应考虑这些因素。

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