Browsing by Subject "Primary care"
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Item Open Access A feasibility study to develop and test a Spanish patient and provider intervention for managing osteoarthritis in Hispanic/Latino adults (PRIMO-Latino).(Pilot and feasibility studies, 2018-01) Corsino, Leonor; Coffman, Cynthia J; Stanwyck, Catherine; Oddone, Eugene Z; Bosworth, Hayden B; Chatterjee, Ranee; Jeffreys, Amy S; Dolor, Rowena J; Allen, Kelli DBackground
Arthritis affects approximately 50 million adults in the USA. Hispanics/Latinos have a higher prevalence of arthritis-attributed activity limitations primarily related to osteoarthritis (OA). Hispanic/Latinos are less likely to receive hip replacement independent of health care access, and they are less likely to receive knee replacement. There have been few interventions to improve OA treatment among the Hispanic/Latino population in the USA. In our study, we aimed to develop and test a telephone delivered culturally appropriate Spanish behavioral intervention for the management of OA in Hispanic/Latino adults.Methods
We conducted a feasibility study in an academic health center and local community in Durham, North Carolina. We enrolled self-identified Spanish speaking overweight/obese adults (≥ 18) with OA of the knee and/or hip under the care of a primary health care provider. The 12-month patient intervention focused on physical activity, weight management, and cognitive behavioral pain management skills. The patient intervention was delivered via telephone with calls scheduled twice per month for the first 6 months, then monthly for the last 6 months (18 sessions). The one-time provider intervention included delivery of patient-specific OA treatment recommendations, based on patients' baseline data and published guidelines. The primary measures were metrics of feasibility, including recruitment and intervention delivery. We also assessed pain, stiffness, and function using the Spanish-Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results
A total of 1879 participants were identified for potential enrollment. Of those, 1864 did not meet inclusion criteria, were not able to be reached or refused. Fifteen participants enrolled in the intervention. The mean number of phone calls completed was 14.7. Eighty percent completed more than 16 calls. The mean WOMAC baseline score (SD) was 39 (20); mean improvement in WOMAC scores between baseline and 12 months, among 11 participants who completed the study, was - 13.27 [95% CI, - 25.09 to - 1.46] points.Conclusion
Recruitment of Hispanics/Latinos, continues to be a major challenge. A Spanish-based telephone delivering lifestyle intervention for OA management in Hispanic/Latino adults is feasible to deliver and may lead to improved OA symptoms. Future research is needed to further test the feasibility and effectiveness of this type of intervention in this segment of the population.Trial registration
NCT01782417.Item Open Access Barriers and Facilitators for Including Village Health Workers (VHW) in Non-communicable Diseases (NCDs) Prevention and Control in Chi Linh District, Hai Duong Province, Vietnam(2017) Long, HongfeiThe burden of non-communicable diseases (NCDs) continues to grow in Vietnam. Recently, Vietnam government initiated a new national plan with a strong focus on NCD prevention and control in the community. This study is intended to investigate the current role of Vietnamese village health workers (VHWs) in preventive and NCD-related care, and to explore the barriers and facilitators to expand the role by including routine community-based NCD prevention and control services. From June to July 2016, four focus group discussions with VHWs (n=24) and thirteen in-depth interviews (n=13) with public health administrators (n=13) were conducted in Chi Lin District, Hai Duong Province, Vietnam. A thematic analysis was conducted to identify themes in the data. The participants identified health education, program outreach, and case management as the current responsibilities of VHW. In NCD programs, VHWs provide these services mostly to hypertension and diabetes patients. Majority of the participants endorsed the idea of incorporating NCD early detection and risk reduction into VHW role and thought their close connection with community justified their strength in conducting these services. Currently perceived barriers included aging VHW, insufficient NCD-related knowledge, poor training quality, imbalanced workload and remuneration, lack of resource, and policy-driven guideline. While, participants believed that upon empowering through training, guidance, and proper incentive, VHWs would serve as effective NCD risk detector and healthy behavior promoter in their communities. The study indicates that, with interpersonal, organizational and policy support, VHWs may have the potential to conduct routine community-based NCD early detection and risk reduction activities in Vietnam.
Item Open Access Comparison of timeline follow-back self-report and oral fluid testing to detect substance use in adult primary care patients.(Drug and alcohol dependence, 2020-02-22) Nordeck, Courtney D; Gryczynski, Jan; O'Grady, Kevin E; Polak, Kathryn; Svikis, Dace S; McNeely, Jennifer; Wu, Li-Tzy; Schwartz, Robert PBACKGROUND:Timeline Follow-back (TLFB) interviews using self-report are often used to assess substance use. Oral fluid testing (OFT) offers an objective measure of substance use. There are limited data on the agreement between TLFB and OFT. METHODS:In this secondary analysis from a multisite study in five primary care sites, self-reported TLFB and OFT data collected under confidential conditions were compared to assess concordance (N=1799). OFT samples were analyzed for marijuana, heroin, cocaine, and non-medical use of prescription opioids. Demographic differences in discordance relative to TLFB and OFT concordant results for marijuana, the only substance with an adequate sample size in this analysis, were examined using multinomial logistic regression. RESULTS:Overall concordance rates between TLFB and OFT were 94.9 % or higher for each substance, driven by large subgroups with no use. Among participants with discordant use, marijuana was the only substance with lower detection on OFT than self-report (27.6 % OFT-positive only vs 32.2 % TLFB-positive only), whereas cocaine (65.6 % vs 8.6 %), prescription opioids (90.4 % vs 6.0 %), and heroin (40.7 % vs 26.0 %) all had higher detection via OFT than TLFB. Participants who reported marijuana use but had a negative OFT were more likely to be younger, Hispanic, and White compared to those with TLFB and OFT concordant positive results. CONCLUSIONS:TLFB and OFT show disparate detection of different substances. Researchers should consider the implications of using either self-report or oral fluid testing in isolation, depending on the substance and collection setting. Triangulating multiple sources of information may improve detection of drug use.Item Open Access Developing a toolkit for implementing evidence-based guidelines to manage hypertension and diabetes in Cambodia: a descriptive case study.(Health research policy and systems, 2022-11) Sivapragasam, Nirmali; Matchar, David B; Chhoun, Pheak; Kol, Hero; Loun, Chhun; Islam, Amina Mahmood; Ansah, John; Yi, SiyanIn Cambodia, economic development accompanied by health reforms has led to a rapidly ageing population and an increasing incidence and prevalence of noncommunicable diseases. National strategic plans recognize primary care health centres as the focal points of care for treating and managing chronic conditions, particularly hypertension and type 2 diabetes. However, health centres have limited experience in providing such services. This case study describes the process of developing a toolkit to facilitate the use of evidence-based guidelines to manage hypertension and type 2 diabetes at the health-centre level. We developed and revised a preliminary toolkit based on the feedback received from key stakeholders. We gathered feedback through an iterative process of group and one-to-one consultations with representatives of the Ministry of Health, provincial health department, health centres and nongovernmental organizations between April 2019 and March 2021. A toolkit was developed and organized according to the core tasks required to treat and manage hypertension and type 2 diabetes patients. The main tools included patient identification and treatment cards, risk screening forms, a treatment flowchart, referral forms, and patient education material on risk factors and lifestyle recommendations on diet, exercise, and smoking cessation. The toolkit supplements existing guidelines by incorporating context-specific features, including drug availability and the types of medication and dosage guidelines recommended by the Ministry of Health. Referral forms can be extended to incorporate engagement with community health workers and patient education material adapted to the local context. All tools were translated into Khmer and can be modified as needed based on available resources and arrangements with other institutions. Our study demonstrates how a toolkit can be developed through iterative engagement with relevant stakeholders individually and in groups to support the implementation of evidence-based guidelines. Such toolkits can help strengthen the function and capacity of the primary care system to provide care for noncommunicable diseases, serving as the first step towards developing a more comprehensive and sustainable health system in the context of population ageing and caring for patients with chronic diseases.Item Open Access Ensuring Healthy Children: The Effect of Health Insurance on Primary Health Care for Children(2010-12-10) Sanderson, AnthonyBackground Past studies have typically focused on the effect of health insurance on primary health care for children, but few have assessed the effect the type of health insurance coverage has on primary care. This research studied the effect of health insurance status—uninsured, private insurance, public coverage, or other insurance—on the accessibility, continuity, and comprehensiveness of primary health care for children. Methods This research analyzed a sample of 39,225 children under 18 years of age from the 2006-2009 National Health Interview Survey, a nationally representative sample of households in the United States. The response rate for children was 75.2 percent. Logistic regression models were used to analyze the effect of health insurance on health status and three aspects of primary care: accessibility (physician visit; usual source of care; time since health professional visit), continuity, (usual source and site of care), and comprehensiveness (physical). Excellent or very good health status was the final dependent variable. Results Compared to children with private health insurance, uninsured children and Medicaid or State Children’s Health Insurance Program (SCHIP) beneficiaries are 27% (p<0.001) and 89.4% (p<0.01) as likely, respectively, to have visited a physician within the last twelve months (LTM). Approximately 73% of uninsured children reported having a usual source of care, compared to 96% of children with private insurance and 98% of Medicaid/SCHIP beneficiaries. Children with private health insurance are at least twice as likely to report “excellent or very good” health as children with any other health insurance status (p<0.001). After controlling for the confounding effects of age, citizenship, mother’s education, father’s education, health status, poverty status, race/ethnicity, and region, Medicaid/SCHIP coverage is associated with similar, if not better, accessibility, continuity, and comprehensiveness of primary care compared to children with private insurance. Conclusions Although by many indicators Medicaid and SCHIP enrollees have worse primary care than children with private health insurance, Medicaid and SCHIP beneficiaries are more likely to have risk factors that are associated with poorer primary care and poorer child health status. Nevertheless, clear relationships cannot be established to conclude how government health insurance programs perform relative to private insurance. Health insurance status is an important predictor, but not the only predictor, of the accessibility, continuity, and comprehensiveness of primary care. Other important risk factors include adolescence, non-U.S. citizenship, low levels of mother’s education, poverty, and residence in the West or South.Item Open Access Identification of barriers at the primary care provider level to improve inflammatory breast cancer diagnosis and management.(Preventive medicine reports, 2023-12) Devi, Gayathri R; Fish, Laura J; Bennion, Alexandra; Sawin, Gregory E; Weaver, Sarah M; Reddy, Katherine; Saincher, Rashmi; Tran, Anh NThe purpose of this study, based in the United States, was to evaluate knowledge gaps and barriers related to diagnosis and care of inflammatory breast cancer (IBC), a rare but lethal breast cancer subtype, amongst Primary Care Providers (PCP) as they are often the first point of contact when patients notice initial symptoms. PCP participants in the Duke University Health System, federally qualified health center, corporate employee health and community practices, nearby academic medical center, Duke physician assistant and advanced practice nurse leadership program alumni were first selected in a convenience sample and for semi-structured interviews (n = 11). Based on these data, an online survey tool was developed and disseminated (n = 78) to assess salient measures of IBC diagnosis, health disparity factors, referral and care coordination practices, COVID-19 impact, and continuing medical education (CME). PCP reported access to care and knowledge gaps in symptom recognition (mean = 3.3, range 1-7) as major barriers. Only 31 % reported ever suspecting IBC in a patient. PCP (n = 49) responded being challenged with referral delays in diagnostic imaging. Additionally, since the COVID-19 pandemic started, 63 % reported breast cancer referral delays, and 33 % reported diagnosing less breast cancer. PCP stated interest in CME in their practice for improved diagnosis and patient care, which included online (53 %), lunch time or other in-service training (33 %), patient and provider-facing websites (32 %). Challenges communicating rare cancer information, gaps in confidence in diagnosing IBC, and timely follow-up with patients and specialists underscores the need for developing PCP educational modules to improve guideline-concordant care.Item Open Access Patient Utilization of Primary Healthcare Services for Cardiovascular Disease in Resource-Limited Settings in Nepal: A Mixed Methods Study(2018) Peoples, NickAbstract
BACKGROUND: Cardiovascular disease (CVD) is the greatest killer of mankind. In Nepal, a small, landlocked country in South Asia and one of the poorest countries in the world, the burden of cardiovascular disease is high; national CVD monitoring has substantial gaps; and CVD risk factors are poorly controlled. Primary healthcare (PHC) is often at the front lines of prevention and control of CVD. Thus, strengthening local and national primary healthcare systems is an essential step toward prevention and management of CVD in low- and middle-income countries (LMICs). To inform further research and policy development, we conducted an exploratory, mixed-methods study to understand patient-side utilization of CVD services in rural and urban areas in Nepal.
METHODS: We surveyed 114 CVD patients from 10 PHC facilities across two regions of Nepal. Survey contents included sociodemographic information, disease history, and data on accessibility, affordability, availability, and utilization of PHC services. We further completed 20 in-depth interviews within our sample to understand patient-side perceptions of CVD-related PHC care.
RESULTS: In the final cohort, 23% had experienced a stroke, 26% had some form of existing heart disease, 76% presented with hypertension, and 67% had diabetes. For all conditions, hospitals were a more common place of diagnosis than PHC facilities. The mean visitation frequency to PHC facilities in the past year was 10.7 times, with healthier patients having higher visitation rates than those with poorer health. 69% of patients reported difficulty obtaining CVD medicine from their local PHC facility. Qualitative data revealed that PHC facilities lacked resources for diagnosing and managing CVD conditions. Additionally, behavior of physicians and affordability were both considered important components of PHC satisfaction. Patient recommendations included increased diagnostic equipment in PHC facilities, free essential medicines, and community awareness initiatives for cardiovascular disease.
CONCLUSION: There are clear shortcomings between national aims and objectives – such as free essential medicines and universal PHC services – and the reality faced by CVD patients in resource-limited settings in Nepal. Despite PHC facilities generally being close to patients, participants reported inadequate resources when seeking care for CVD and expressed a strong desire that such services could be provided locally. Based on the challenges articulated by CVD patients in our study, mhealth may be a relevant direction of future research for connecting hospital-based specialists to CVD patients in rural areas, improving follow-up, and decreasing expensive visits to far away tertiary care centers. Overall, we recommend increased national CVD monitoring, prioritization of NCDs and CVDs in national policymaking and strategizing, and continued provision of PHC facilities close to patients in their communities.
Keywords: primary care, cardiovascular, utilization, Nepal, public healthcare facilities
DEDICATION
Item Open Access Practice Patterns and Influential Factors of Nurse Practitioners Managing Chronic Pain(2021) Nikpour, JacquelineChronic pain impacts 100 million adult Americans in their lifetime, comprises the third-highest category of all health spending, and is responsible for up to 20% of primary care visits. Chronic pain treatment guidelines: recommend a biopsychosocial, multimodal management approach that addresses the physical and mental aspects of chronic pain. Nurse practitioners (NPs) have a unique role to play in chronic pain, due to their biopsychosocial training in chronic disease management in primary care that aligns well with this recommended approach. However, little is known about how NPs manage chronic pain or factors that influence those patterns. These gaps have implications on NP regulation and workforce development, as well as primary care transformation and clinical practice. Therefore, the purpose of this dissertation is to understand primary care NPs’ opioid and non-opioid prescribing patterns and the patient, provider, and system-level factors that influence those patterns.This dissertation includes a scoping review in Chapter 2 that demonstrates the negative impact of NP regulatory restrictions on patient access to chronic pain care, as well as treatment for OUD. Chapter 3 features a systematic review that examines primary care chronic pain prescribing patterns among physicians, NPs, and physician assistants (PA). This chapter highlights the lack of literature on NP and PA prescribing patterns specific to primary care, as well as the lack of prescribing pattern literature on non-opioid and non-pharmacologic modalities, despite the recommendations of these therapies in multiple national chronic pain guidelines. Chapter 4 presents the findings of a 31-item survey, developed by the authors, of 128 NPs from across the U.S. This survey examined the challenges and experiences of NPs who manage chronic pain and analyzed the impact of those experiences on the frequency with which NPs prescribe various pharmacologic and non-pharmacologic pain therapies. Findings indicate that NPs strongly identified with a variety of chronic pain management challenges, including patient access and insurance coverage of non-pharmacologic care, regulatory restrictions, and concerns of misuse. Additionally, NP-level factors such as setting of practice and education level significantly impacted NPs’ prescribing patterns and their perception of difficulty in managing chronic pain. Finally, Chapter 5 utilized a national VA dataset, including 39,936 12-month summary records between patients and their primary care providers, to compare opioid and non-opioid prescribing patterns of physicians, NPs, and PAs. After adjusting for patient factors, physicians had the highest odds of prescribing opioids and non-opioids compared to NPs and PAs. However, very small effect sizes may indicate that these differences do not hold significant clinical meaning. Patient factors, such as race/ethnicity, gender, age, level of education, number of comorbidities, number of chronic pain diagnoses, and self-reported health and mental health statuses, influenced prescription of opioid and non-opioid medications after adjusting for all other variables. Chronic pain is an exemplar of necessary primary care transformation priorities, including primary and behavioral health integration, value-based payment and delivery, team-based and well-coordinated care, and promotion accessible, equitable care. NPs are well-suited to address the complex needs of chronic pain patients. The findings of this dissertation indicate that NPs are slightly less likely than physicians to prescribe opioids and non-opioids; however, patient characteristics may increase the odds of a medication prescription more so than provider type. Furthermore, these findings identify patient, provider, and system-level challenges that NPs experience while managing chronic pain. The findings of this dissertation may contribute to important advancements in policy, practice, education, and research.
Item Open Access Primary care multidisciplinary teams in practice: a qualitative study.(BMC Fam Pract, 2017-12-29) Leach, Brandi; Morgan, Perri; Strand de Oliveira, Justine; Hull, Sharon; Østbye, Truls; Everett, ChristineBACKGROUND: Current recommendations for strengthening the US healthcare system consider restructuring primary care into multidisciplinary teams as vital to improving quality and efficiency. Yet, approaches to the selection of team designs remain unclear. This project describes current primary care team designs, primary care professionals' perceptions of ideal team designs, and perceived facilitating factors and barriers to implementing ideal team-based care. METHODS: Qualitative study of 44 health care professionals at 6 primary care practices in North Carolina using focus group discussions and surveys. Data was analyzed using framework content analysis. RESULTS: Practices used a variety of multidisciplinary team designs with the specific design being influenced by the social and policy context in which practices were embedded. Practices overwhelmingly located barriers to adopting ideal multidisciplinary teams as being outside of their individual practices and outside of their control. Participants viewed internal organizational contexts as the major facilitators of multidisciplinary primary care teams. The majority of practices described their ideal team design as including a social worker to meet the needs of socially complex patients. CONCLUSIONS: Primary care multidisciplinary team designs vary across practices, shaped in part by contextual factors perceived as barriers outside of the practices' control. Facilitating factors within practices provide a culture of support to team members, but they are insufficient to overcome the perceived barriers. The common desire to add social workers to care teams reflects practices' struggles to meet the complex demands of patients and external agencies. Government or organizational policies should avoid one-size-fits-all approaches to multidisciplinary care teams, and instead allow primary care practices to adapt to their specific contextual circumstances.Item Open Access Recent and active problematic substance use among primary care patients: Results from the alcohol, smoking, and substance involvement screening test in a multisite study.(Substance abuse, 2021-04-02) John, William S; Zhu, He; Greenblatt, Lawrence H; Wu, Li-TzyBackground: Primary care settings provide salient opportunities for identifying patients with problematic substance use and addressing unmet treatment need. The aim of this study was to examine the extent and correlates of problematic substance use by substance-specific risk categories among primary care patients to inform screening/intervention efforts. Methods: Data were analyzed from 2000 adult primary care patients aged ≥18 years (56% female) across 5 clinics in the eastern U.S. Participants completed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Prevalence and ASSIST-defined risk-level of tobacco use, alcohol use, and nonmedical/illicit drug use was examined. Multinomial logistic regression models analyzed the demographic correlates of substance use risk-levels. Results: Among the total sample, the prevalence of any past 3-month use was 53.9% for alcohol, 42.0% for tobacco, 24.2% for any illicit/Rx drug, and 5.3% for opioids; the prevalence of ASSIST-defined moderate/high-risk use was 45.1% for tobacco, 29.0% for any illicit/Rx drug, 14.2% for alcohol, and 9.1% for opioids. Differences in the extent and risk-levels of substance use by sex, race/ethnicity, and age group were observed. Adjusted logistic regression showed that male sex, white race, not being married, and having less education were associated with increased odds of moderate/high-risk use scores for each substance category; older ages (versus ages 18-25 years) were associated with increased odds of moderate/high-risk opioid use. Conclusions: Intervention need for problematic substance use was prevalent in this sample. Providers should maintain awareness and screen for problematic substance use more consistently in identified high risk populations.Item Open Access Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal.(Pilot Feasibility Stud, 2018) Kohrt, Brandon A; Jordans, Mark JD; Turner, Elizabeth L; Sikkema, Kathleen J; Luitel, Nagendra P; Rai, Sauharda; Singla, Daisy R; Lamichhane, Jagannath; Lund, Crick; Patel, VikramBackground: Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap,REducingStigma amongHealthcAreProviders to ImprovEmental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services into primary healthcare. Methods: This protocol describes a mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal. The qualitative component will include key informant interviews and focus group discussions. The quantitative component consists of a pilot cluster randomized controlled trial (c-RCT), which will establish parameters for a future effectiveness study of RESHAPE compared to training as usual (TAU). Primary healthcare facilities (the cluster unit,k = 34) will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention are the primary healthcare workers in the facilities (n = 150); indirect beneficiaries are their patients (n = 100). The TAU condition is existing mental health training and supervision for primary healthcare workers delivered through the Programme for Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme (mhGAP). The primary objective is to evaluate acceptability and feasibility through qualitative interviews with primary healthcare workers, trainers, and mental health service users. The secondary objective is to collect quantitative information on health worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge (mhGAP), clinical competency (ENhancing Assessment of Common Therapeutic factors, ENACT), and implicit attitudes (Implicit Association Test, IAT), and patient outcomes including stigma-related barriers to care, daily functioning, and symptoms. Discussion: The pilot and feasibility study will contribute to refining recommendations for implementation of mhGAP and other mental health services in primary healthcare settings in low-resource health systems. The pilot c-RCT findings will inform an effectiveness trial of RESHAPE to advance the evidence-base for optimal approaches to training and supervision for non-specialist providers. Trial registration: ClinicalTrials.gov identifier, NCT02793271.Item Open Access Role of caregiver factors in outpatient medical follow-up post-stroke: observational study in Singapore.(BMC family practice, 2021-04-14) Tyagi, Shilpa; Koh, Gerald Choon-Huat; Luo, Nan; Tan, Kelvin Bryan; Hoenig, Helen; Matchar, David B; Yoong, Joanne; Chan, Angelique; Lee, Kim En; Venketasubramanian, N; Menon, Edward; Chan, Kin Ming; De Silva, Deidre Anne; Yap, Philip; Tan, Boon Yeow; Chew, Effie; Young, Sherry H; Ng, Yee Sien; Tu, Tian Ming; Ang, Yan Hoon; Kong, Keng He; Singh, Rajinder; Merchant, Reshma A; Chang, Hui Meng; Yeo, Tseng Tsai; Ning, Chou; Cheong, Angela; Ng, Yu Li; Tan, Chuen SengBackground
Outpatient medical follow-up post-stroke is not only crucial for secondary prevention but is also associated with a reduced risk of rehospitalization. However, being voluntary and non-urgent, it is potentially determined by both healthcare needs and the socio-demographic context of stroke survivor-caregiver dyads. Therefore, we aimed to examine the role of caregiver factors in outpatient medical follow-up (primary care (PC) and specialist outpatient care (SOC)) post-stroke.Method
Stroke survivors and caregivers from the Singapore Stroke Study, a prospective, yearlong, observational study, contributed to the study sample. Participants were interviewed 3-monthly for data collection. Counts of PC and SOC visits were extracted from the National Claims Database. Poisson modelling was used to explore the association of caregiver (and patient) factors with PC/SOC visits over 0-3 months (early) and 4-12 months (late) post-stroke.Results
For the current analysis, 256 stroke survivors and caregivers were included. While caregiver-reported memory problems of a stroke survivor (IRR: 0.954; 95% CI: 0.919, 0.990) and caregiver burden (IRR: 0.976; 95% CI: 0.959, 0.993) were significantly associated with lower early post-stroke PC visits, co-residing caregiver (IRR: 1.576; 95% CI: 1.040, 2.389) and negative care management strategies (IRR: 1.033; 95% CI: 1.005, 1.061) were significantly associated with higher late post-stroke SOC visits.Conclusion
We demonstrated that the association of caregiver factors with outpatient medical follow-up varied by the type of service (i.e., PC versus SOC) and temporally. Our results support family-centred care provision by family physicians viewing caregivers not only as facilitators of care in the community but also as active members of the care team and as clients requiring care and regular assessments.