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Oliva-Moreno J, Peña-Longobardo LM, Mar J, Masjuan J, Soulard S, Gonzalez-Rojas N, Becerra V, Casado MÁ, Torres C, Yebenes M, Quintana M, Alvarez-Sabín J. Determinants of Informal Care, Burden, and Risk of Burnout in Caregivers of Stroke Survivors. Stroke 2018; 49:140-146. [DOI: 10.1161/strokeaha.117.017575] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 12/26/2022]
Abstract
Background and Purpose—
The aim of this article was to analyze the likelihood of receiving informal care after a stroke and to study the burden and risk of burnout of primary caregivers in Spain.
Methods—
The CONOCES study is an epidemiological, observational, prospective, multicenter study of patients diagnosed with stroke and admitted to a Stroke Unit in the Spanish healthcare system. At 3 and 12 months post-event, we estimated the time spent caring for the patient and the burden borne by primary caregivers. Several multivariate models were applied to estimate the likelihood of receiving informal caregiving, the burden, and the likelihood of caregivers being at a high risk of burnout.
Results—
Eighty percent of those still alive at 3 and 12 months poststroke were receiving informal care. More than 40% of those receiving care needed a secondary caregiver at 3 months poststroke. The likelihood of receiving informal care was associated with stroke severity and the individual’s health-related quality of life. When informal care was provided, both the burden borne by caregivers and the likelihood of caregivers being at a high risk of burnout was associated with (1) caregiving hours; (2) the patient’s health-related quality of life; (3) the severity of the stroke measured at discharge; (4) the patient having atrial fibrillation; and (5) the degree of dependence.
Conclusions—
This study reveals the heavy burden borne by the caregivers of stroke survivors. Our analysis also identifies explanatory and predictive variables for the likelihood of receiving informal care, caregiver burden, and high risk of burnout.
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Affiliation(s)
- Juan Oliva-Moreno
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Luz María Peña-Longobardo
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Javier Mar
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Jaime Masjuan
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Stéphane Soulard
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Nuria Gonzalez-Rojas
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Virginia Becerra
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Miguel Ángel Casado
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Covadonga Torres
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - María Yebenes
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Manuel Quintana
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Jose Alvarez-Sabín
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
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Mar J, Masjuan J, Oliva-Moreno J, Gonzalez-Rojas N, Becerra V, Casado MÁ, Torres C, Yebenes M, Quintana M, Alvarez-Sabín J. Outcomes measured by mortality rates, quality of life and degree of autonomy in the first year in stroke units in Spain. Health Qual Life Outcomes 2015; 13:36. [PMID: 25889480 PMCID: PMC4391532 DOI: 10.1186/s12955-015-0230-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/03/2015] [Indexed: 12/21/2022] Open
Abstract
Introduction The primary objective of this sub analysis of the CONOCES study was to analyse outcomes in terms of mortality rates, quality of life and degree of autonomy over the first year in patients admitted to stroke units in Spain. The secondary objective was to identify the factors determining good prognosis. Methods We studied a sample of patients who had suffered a confirmed stroke and been admitted to a Stroke Unit in the Spanish healthcare system. Socio-demographic and clinical variables and variables related to the level of severity (NIHSS), the level of autonomy (Barthel, modified Rankin) and quality of life (EQ-5D) were recorded at the time of admission and then three months and one year after the event. Factors determining prognosis were analysed using logistic regression and ROC curves. Results A total of 321 patients were recruited, 33% of whom received thrombolytic treatment, which was associated with better results on the Barthel and the modified Rankin scales and in terms of the risk of death. Mean quality of life measured through EQ-5D improved from 0.57 at discharge to 0.65 one year later. Full autonomy level measured by Barthel index increased from 30.1% at discharge to 52.8% at one year and by the modified Rankin scale from 51% to 71%. The rates for in-hospital and 1-year mortality were 5.9% and 17.4% respectively. Low NIHSS scores were associated with a good prognosis with all the outcome variables. The three instruments applied (NIHSS, Barthel and modified Rankin scales) on admission showed good discriminative ability for patient prognosis in the ROC curves. Conclusions There has been a change in the prognosis for stroke in Spain in recent years as the quality of life at 1 year observed in our study is clearly higher than that obtained in other Spanish studies conducted previously. Moreover, survival and functional outcome have also improved following the introduction of a new model of care. These results clearly promote extension of the model based on stroke units and reinforced rehabilitation to the majority of the more than 100,000 strokes that occur annually in Spain.
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Affiliation(s)
- Javier Mar
- Clinical Management Service, Alto Deba Hospital, Mondragon, Spain. .,Unidad de Gestión Sanitaria, Hospital 'Alto Deba', Avenida Navarra 16, 20500, Mondragón, Spain.
| | - Jaime Masjuan
- Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Madrid, Spain.
| | - Juan Oliva-Moreno
- Department of Economic Analysis, Universidad de Castilla La Mancha and REDISSEC, Toledo, Spain.
| | - Nuria Gonzalez-Rojas
- Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain.
| | - Virginia Becerra
- Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain.
| | | | | | - María Yebenes
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain.
| | - Manuel Quintana
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain.
| | - Jose Alvarez-Sabín
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain.
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de Andrés-Nogales F, Vivancos Mora J, Barriga Hernández FJ, Díaz Otero F, Izquierdo Esteban L, Ortega-Casarrubios MÁ, Castillo Moreno L, Ximénez-Carrillo Rico Á, Martín Torres MP, Gómez-Escalonilla Escobar CI, Torres González C, de Salas-Cansado M, Casado Gómez MÁ, Soto Álvarez J, Gil-Núñez A. Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study. Neurologia 2014; 30:536-44. [PMID: 25066492 DOI: 10.1016/j.nrl.2014.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/21/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. METHODS A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. RESULTS During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. CONCLUSIONS Acute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation.
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Affiliation(s)
- F de Andrés-Nogales
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España.
| | - J Vivancos Mora
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, España
| | | | - F Díaz Otero
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Izquierdo Esteban
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | | | | | - Á Ximénez-Carrillo Rico
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, España
| | | | | | - C Torres González
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - M de Salas-Cansado
- Departamento de Investigación de Resultados en Salud y Farmacoeconomía, Pfizer S. L. U., Alcobendas, Madrid, España
| | - M Á Casado Gómez
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - J Soto Álvarez
- Departamento de Investigación de Resultados en Salud y Farmacoeconomía, Pfizer S. L. U., Alcobendas, Madrid, España
| | - A Gil-Núñez
- Hospital General Universitario Gregorio Marañón, Madrid, España
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