Olaiya Muideen T, Cadilhac Dominique A, Kim Joosup, Nelson Mark R, Srikanth Velandai K, Andrew Nadine E, Bladin Christopher F, Gerraty Richard P, Fitzgerald Sharyn M, Phan Thanh, Frayne Judith, Thrift Amanda G
From Stroke and Ageing Research (M.T.O., D.A.C., J.K., V.K.S., N.E.A., T.P., A.G.T.), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; Stroke Division (D.A.C., J.K., N.E.A.), Florey Institute of Neuroscience and Mental Health, Heidelberg; Menzies Institute for Medical Research (M.R.N., V.K.S.), Hobart; Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne; School of Medicine (M.R.N.), University of Tasmania, Hobart; Department of Neurosciences (C.F.B.), Box Hill Hospital; Department of Medicine (R.P.G.), Epworth Healthcare, Monash University, Richmond; and Department of Neurology (J.F.), Alfred Hospital, Melbourne, Australia.
Neurology. 2017 Jul 4;89(1):68-75. doi: 10.1212/WNL.0000000000004063. Epub 2017 May 31.
To extensively investigate long-term unmet needs in survivors of stroke or TIA and to identify factors associated with these unmet needs.
Community-dwelling adults were invited to participate in a survey ≥2 years after discharge for stroke/TIA. Unmet needs were assessed across 5 domains: activities and participation, environmental factors, body functions, post-acute care, and secondary prevention. Factors associated with unmet needs were determined with multivariable negative binomial regression.
Of 485 participants invited to complete the survey, 391 (81%) responded (median age 73 years, 67% male). Most responders (87%) reported unmet needs in ≥1 of the measured domains, particularly in secondary prevention (71%). Factors associated with fewer unmet needs included older age (incident rate ratio [IRR] 0.62, 95% confidence interval [CI] 0.50-0.77), greater functional ability (IRR 0.33, 95% CI 0.17-0.67), and reporting that the general practitioner was the most important in care (IRR 0.69, 95% CI 0.57-0.84). Being depressed (IRR 1.61, 95% CI 1.23-2.10) and receiving community services after stroke (IRR 1.45, 95% CI 1.16-1.82) were associated with more unmet needs.
Survivors of stroke/TIA reported considerable unmet needs ≥2 years after discharge, particularly in secondary prevention. The factors associated with unmet needs could help guide policy decisions, particularly for tailoring care and support services provided after discharge.
广泛调查中风或短暂性脑缺血发作（TIA）幸存者长期未满足的需求，并确定与这些未满足需求相关的因素。
邀请社区居住的成年人在中风/TIA出院≥2年后参与一项调查。在5个领域评估未满足的需求：活动与参与、环境因素、身体功能、急性后期护理和二级预防。通过多变量负二项回归确定与未满足需求相关的因素。
在受邀完成调查的485名参与者中，391名（81%）做出了回应（中位年龄73岁，67%为男性）。大多数回应者（87%）报告在≥1个测量领域存在未满足的需求，尤其是在二级预防方面（71%）。与较少未满足需求相关的因素包括年龄较大（发生率比[IRR]0.62，95%置信区间[CI]0.50 - 0.77）、功能能力较强（IRR 0.33，95% CI 0.17 - 0.67）以及报告全科医生在护理中最为重要（IRR 0.69，95% CI 0.57 - 0.84）。抑郁（IRR 1.61，95% CI 1.23 - 2.10）和中风后接受社区服务（IRR 1.45，95% CI 1.16 - 1.82）与更多未满足需求相关。
中风/TIA幸存者在出院≥2年后报告了相当多未满足的需求，尤其是在二级预防方面。与未满足需求相关的因素有助于指导政策决策，特别是在定制出院后提供的护理和支持服务方面。
