A process evaluation of a stroke-specific follow-up care model for stroke patients and caregivers; a longitudinal study

被引：18

作者：

Fens M. ^{[1
,2
]}

Beusmans G. ^{[2
,3
]}

Limburg M. ^{[4
]}

van Hoef L. ^{[1
,2
]}

van Haastregt J. ^{[2
,5
]}

Metsemakers J. ^{[1
,2
,3
]}

van Heugten C. ^{[6
,7
]}

机构：

[1] Department of Patient and Care, Maastricht University Medical Centre+, Maastricht

[2] CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht

[3] Department of General Practice, Maastricht University Medical Centre+, Maastricht

[4] Department of Neurology, Flevo Hospital, Almere

[5] Department of Health Services Research, Maastricht University, Maastricht

[6] Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, PO Box 616, Maastricht

[7] Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neurosciences, Maastricht University, Maastricht

来源：

BMC Nursing | / 14卷 / 1期

关键词：

Follow-up care; Nurses; Process assessment; Stroke;

D O I：

10.1186/s12912-014-0052-8

中图分类号：

学科分类号：

摘要：

Background: There is a need for follow-up care after stroke, but there is no consensus about the way to organise it. An intervention providing follow-up care for stroke patients and caregivers showed favourable effects on the level of social activities, but no other effects were found. The intervention consists of a maximum of five home visits to patients and caregivers during a period of 18 months post-discharge. The home visits are conducted by a stroke care coordinator (SCC) using a structured assessment tool. The objective of this study was to examine process-related factors that could have influenced the effectiveness of the intervention. Methods: 77 stroke patients, 59 caregivers and 4 SCCs participated in the study. Data on the organisational characteristics of and the satisfaction with the intervention were collected by means of structured assessments, interviews and self-administered questionnaires at 1, 6, 12 and 18 months of follow-up. The intervention was provided between April 2008 and June 2011. Results: Patients received an average of 3.8 home visits (SD 1.4) and 55% of them had a follow-up period of a maximum of 18 months. There were 1074 problems identified and the SCCs initiated 363 follow-up care and referral options. Stroke patients and caregivers were very satisfied with the intervention. The SCCs were satisfied with the assessment tool, but would like to see a structured referral system. Conclusions: The intervention was only partially performed in accordance with the protocol and was positively evaluated by patients, caregivers and SCCs. It is recommended to add a structured referral system to the intervention. © 2015 Fens et al.

引用

共 27 条

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