Effectiveness Continuing of Care in Community among Intermediate Care of Stroke Patients, Mueang Chaiyaphum District

Abstract

This retrospective study aimed to investigate the effects of community-based follow-up care in stroke patients during the intermediate phase in Mueang District, Chaiyaphum Province. The study involved 90 stroke patients whom admitted in Chaiyaphum Hospital between August 2022 and May 2023. A home health care approach was used to assess the patients' ability to perform daily activities (Barthel ADL Index: BI) and provide rehabilitation support for 6 months after discharge from the hospital. Data on medical history was collected from the HOSxP database, and data on home-based follow-up care during the rehabilitation phase was collected through observation and interviews. Descriptive statistics were used to analyze the data, and inferential statistics were performed using paired t-test, McNemar’s test ,Cochran Q test and Simple logistic regression.

The study results showed that the majority of the sample were male (60.0%) with an average age of 65.4±4.7 years , 77.8% were ischemic stroke patients.  On the day of discharge from the hospital, 74.4% had a BI score <11 . After 6 months of continuing of care at home in community showed that, 83.3% had increase of BI scores, 50% had fully BI scores (20 points), 13.3% were deaths whom had average age of 78.5±7.4 years and history of chronic disease. When comparing the average BI scores, it was found that after 6 months of follow-up care, the average BI score increased by 9.5 points (95% CI: 8.5, 10.6). Furthermore, it was found that a higher initial stroke severity (NIHSS≥ 15 points) was associated with a 6-fold increased risk of long-term care or death (BI<11/dead) during the 6-month rehabilitation period (OR = 6.2; 95% CI: 1.2, 31.5).

In conclusion, continuous community-based care for stroke patients during the intermediate phase by a multidisciplinary team in collaboration with community networks and families had encouraged and supported majority of patients to improve ability self-care. However, in severe cases or BI score very low cases are necessary to appropriate care plan before discharge from the hospital.