'Access' means absolutely nothing, survivors want recovery! Are you that blitheringly stupid?
DETERMINANTS OF ACCESS TO REHABILITATION PROFESSIONALS BY POST-STROKE INDIVIDUALS IN THE FIRST SIX MONTHS AFTER HOSPITAL DISCHARGE
Background
Currently, the best strategy to deal with disabilities after stroke is rehabilitation. National and international clinical guidelines recommend that all post-stroke individuals have access to rehabilitation professionals within 72 hours after hospital discharge. In addition, access should be continued until the individual's functional goals are achieved. However, the determinants of access to rehabilitation professionals by post-stroke individuals in middle-income countries, where the burden of this disease is high, are little known.
Objectives
To identify the determinants of access to rehabilitation professionals by post-stroke individuals one, three and six months after hospital discharge in Brazil and to compare the access obtained in each period with that referred by the multidisciplinary team at the time of hospital discharge.
Methods
A longitudinal, prospective, and exploratory study, carried out in Belo Horizonte, Minas Gerais, Brazil. Individuals after primary stroke, without previous disabilities were included. During hospital discharge, the number of rehabilitation professionals referred by the multidisciplinary team was recorded. One, three and six months after hospital discharge, individuals were contacted by telephone to identify the rehabilitation professionals accessed. Possible determinants of access were classified according to Andersen's behavioral model for using health services and included: a) predisposing factors: age, sex, education, and belief that it could improve with treatment; b) need factors: stroke severity and level of disability; c) facilitating factors: socioeconomic status, disposable income for health care and quality of care provided by rehabilitation professionals. Multiple linear regression model and Wilcoxon test were used (α=5%).
Results
201 individuals were included. Higher level of disability and stroke severity explained 31%, 34% and 39% of access to rehabilitation professionals one, three and six months after hospital discharge (p<0.01) respectively. Three months after discharge, having less education added 4% of explanation to the variation in access (p<0.01). In all evaluated periods, the number of professionals accessed was significantly lower than recommended at discharge (p<0.01).
Conclusion
In general, individuals with a more severe stroke and a higher level of disability were those who had greater access to rehabilitation professionals one, three and six months after hospital discharge. In addition, the comprehensiveness care for post-stroke individuals were compromised was compromised in all periods evaluated, indicating that current legislation in Brazil on post-stroke individuals care was partially complied.
Implications
Access to rehabilitation professionals has been directed equitably and in insufficient quantity to post-stroke individuals. Therefore, health management services must direct human and financial resources to expand immediate and comprehensive access to rehabilitation professionals for all post-stroke individuals after hospital discharge. These resources can improve the resolution of the transfer from hospital care to community care, as recommended.
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