Smeeton Nigel C, Corbin David O C, Hennis Anselm J, Hambleton Ian R, Fraser Henry S, Wolfe Charles D A, Heuschmann Peter U
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.
Cerebrovasc Dis. 2009;27(4):328-35. doi: 10.1159/000202009. Epub 2009 Feb 14.
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.
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.
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).
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.
比较中低收入国家中风患者与高收入国家类似患者在中风后接受的医疗保健类型和数量方面的医疗保健利用情况。
收集了2001年1月至2004年12月基于人群的南伦敦中风登记册（SLSR）和巴巴多斯中风登记册（BROS）的数据。通过多变量逻辑回归对急性期使用的管理和诊断程序差异进行年龄、性别、种族、中风前生活条件和社会经济地位的调整。对中风后3个月和1年的后续管理进行比较。
BROS的患者住院的可能性较小（比值比0.22；95%置信区间0.13 - 0.37），但BROS中脑部扫描使用较少的差异较小（比值比0.62；95%置信区间0.25 - 1.52）。对中风严重程度（格拉斯哥昏迷评分）进行额外调整后显示，BROS患者入院时更有可能进行吞咽测试（比值比2.95；95%置信区间1.17 - 7.45）。BROS患者在3个月时接受护理的可能性较小（比值比0.37；95%置信区间0.17 - 0.81），在3个月（比值比0.10；95%置信区间0.03 - 0.33）和1年（比值比0.05；95%置信区间0.00 - 0.55）时接受言语和语言治疗的可能性也较小。
3个月时住院和护理使用较少表明，在巴巴多斯，家人和朋友在中风时及之后的中期对患者护理承担了更大的责任。
