Predictors of access to healthcare services within 1 month after stroke in a developing country: A longitudinal prospective study

Abstract

AbstractBackgroundGlobally, people with disabilities face difficulties accessing care, resulting in worse health outcomes and higher healthcare costs. However, information regarding access to healthcare services for stroke survivors in developing countries is scarce.ObjectiveTo identify predictors of access to healthcare services within 1 month of hospital discharge in a developing country (Brazil).MethodsFor six months, individuals from a stroke unit, aged ≥20 years, after their first stroke and without previous disability, were included and evaluated at hospital discharge for socio‐demographic (sex, age, education, and socio‐economic level) and clinical‐functional (severity of stroke and level of disability) characteristics. The number and type of referrals to healthcare services provided by hospital staff were also recorded. One month after hospital discharge, data regarding access to healthcare services obtained by the subjects were collected. The Wilcoxon test was used to compare the number of referrals and access to healthcare services obtained by the subjects. To identify the predictors of access, a binary logistic regression was used (α = 5%).ResultsA total of 78 individuals were evaluated one month after hospital discharge, all with at least one referral. The total access to healthcare services within 1 month of stroke was significantly lower than the total number of referrals (p < 0.001). Sex (odds ratios (OR) = 18.92; p = 0.01) and educational level (OR = 1.48; p = 0.04) were significant predictors of access.ConclusionsBeing female and having low education levels were predictors of access to healthcare services within 1 month of stroke in a developing country. In addition, the access was below expectations, compromising the integrality of care and national and international recommendations, which is a concern given the need for early care to obtain better results in health and functional outcomes.