Caregivers key component in poststroke care

Caregivers play a big role in poststroke outpatient follow-ups, according to a recent Singapore study. While a co-residing caregiver encourages late poststroke specialist outpatient care (SOC) visits, caregiver burden lessens early visits to primary care (PC).

“We are the first to determine caregiver factors associated with outpatient medical follow-up poststroke,” the researchers said. “[W]e reported caregiver factors significantly associated with both PC and SOC visits, establishing caregivers’ role in outpatient medical follow-up poststroke.”

Enrolling from the Singapore Stroke Study, the researchers conducted a prospective observational study on 256 eligible survivor-caregiver dyads. PC and SOC visits were counted using the National Claims Database, and relevant patient- and caregiver-related factors were obtained through interviews every 3 months.

On average, survivors visited PC clinics 0.867±1.197 times during the first 0–3 months poststroke, and 2.305±2.242 times 4–12 months after. The corresponding number of SOC visits during the respective time frames were 1.836±1.823 and 4.605±5.616 times. [BMC Fam Pract 2021;22:74]

Poisson regression models showed that both caregiver and patient characteristics were important determinants of poststroke care-seeking. For instance, memory problems of the patient, as reported by the caregiver, emerged as a deterrent for early PC visits (incidence rate ratio [IRR] for each 1-unit increase in memory problem score, 0.954, 95 percent confidence interval [CI], 0.919–0.990).

Similarly, each unit increase in the Oberst caregiver burden scale score significantly reduced PC visits within 3 months after stroke (IRR, 0.976, 95 percent CI, 0.959–0.993).

In the model for late visits (4–12 months poststroke), the researchers found that having more comorbidities and ischaemic stroke were more likely to present to PC clinics, while those who had moderately severe vs mild strokes were less likely to do so.

In terms of specialist care, survivors who co-resided with their caregivers had a nearly 60-percent greater rate of SOC visits 4–12 months after stroke (IRR, 1.576, 95 percent CI, 1.040–2.389). A similar but weaker effect was observed for survivors whose caregivers adopted a negative care management strategy (IRR for every 1 unit increase in negative care strategy score, 1.033, 95 percent CI, 1.005–1.061).

Negative care strategies included acting angry or yelling at the survivor in order to get them to follow, as opposed to positive care, which instead focused on praise and appreciation.

“After establishing the role of caregivers in outpatient medical follow-up poststroke, we recommend family physicians view caregivers not only as facilitators of care in the community but also as active members of the care team responsible for patient care and as potential clients requiring care and regular assessments,” the researchers said.

“Caregivers should be integrated into the care teams by practicing inclusive care, which also ensures the extension of the healthcare team in the home environment,” they added.