A PILOT-STUDY OF REHABILITATION AT HOME AFTER STROKE - A HEALTH-ECONOMIC APPRAISAL

This study aimed at describing the health-economic implications and or ganisational issues of rehabilitation at home in south-west Stockholm of 15 acute stroke patients, mean age 68.2, male:female ratio 9:6, ind ependent in feeding and continent one week after their stroke, Average patient satisfaction with different dimensions of care was 99%, Perce ived dysfunction, by means of the Sickness Impact Profile, 3 months af ter stroke was highest for Recreation-and-Pastime, Home Management and Ambulation, Between 3-12 months after stroke, functional improvement was particularly seen in Home;Management, Recreation-and-Pastime and E motional Behaviour, Three fourths of the patients received help with d ifferent ADL tasks from a family caregiver and 1/5 from home service a ssistants, According to the scores for subjective health of the spouse s and time used to help the patient, the burden that the programme put on the patient's family was modest, temporary and in accordance with preferences reported by the elderly in Sweden, The mean duration of ho spital stay for patients under rehabilitation at home was 14 days and for a selected comparison group with similar ADL-grade, 27 days, The m ean number of therapy sessions at home was 11, Each home visit took 3. 2 hours, 60% of which were direct patient time, In the selected compar ison group, 1/3 was referred to other departments for rehabilitation a nd care, and 40% had contacts with day-care and paramedical profession als after discharge from the hospital, During the first year after str oke, the average, direct, per capita cost for rehabilitation at home a mounted to SEK 127,730 divided between hospital care (50%), followed b y contribution by family caregivers (18%), rehabilitation at home (10% ), out-patient visits to physicians and nurses (8.8%), home-help servi ce (7%), auxiliary equipment (2%), medication (1.5%), home adaptation (1%) and transportation service (0.3%), This organisational model of h ome-based rehabilitation of stroke patients constitutes a feasible, po ssibly less expensive alternative and complement to current rehabilita tion in hospital and primary care, which could be further developed an d evaluated.