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Session: Informal Care
Room: Main Hall
Time: Thu 11:45-13:00

Presenter: Alessandra Susi (Bocconi University. IAM)

Abstract

Rationale and objectives:
Informal care is a major component of societal costs in stroke and its impact on formal care is largely under investigated. On the basis of a major database on post stroke patients in Italy with a 12 months follow-up, we tested the hypothesis that the presence of a care giver and/or the amount of informal care can be associated to direct healthcare costs.
Methods:
Primary caregivers of stroke patients enrolled in the Italian study were interviewed at 3, 6 and 12 months after the acute event and data on informal care provided were documented. Two models were designed to evaluate whether the amount of informal care or the presence of the informal caregiver produced any relevant effect on the use of healthcare services in the 12 months after stroke. The first model was a multivariate ordinary least-squares regression model (OLS) and it controlled for organizational, socio-demographic, clinical variables and for functional and quality of life outcomes. In the normal Multilevel Random Effect Model (MLM) the hierarchical structure of the data was taken into account: organizational variables were inserted as hospital level covariates, while socio demographic, functional and quality of life were considered at patient level. Both models were controlled for availability of healthcare services in the region.
Results: Based on data on 437 stroke survivors followed up for one year after admission in 44 hospitals, we estimated cost of informal care at one year to be € 6,453 ± 3,805 per stroke survivor (€ 12,695 ± 4,474 per user). Informal caregivers were present at 216 patients. Majority of caregivers are women (84.3%), above 65 years (46.9%) and housekeepers (39.4%). Average amount of informal care was 8.39±7.06 hours per user per day. Both OLS and MLM model showed that the presence of caregivers is associated with higher consumption of healthcare resources at one year after acute event. Overall, the presence of the caregiver is associated to a 76% increase in direct healthcare costs (P<0.001). In particular, patients with caregivers use more inpatient rehabilitation (p=0.02) and specialists’ visits (p=0.003). On the contrary, use of GP visits, imaging diagnostics, pharmaceuticals and hospital care do not appear affected by the presence of caregiver.

Conclusions: While informal care is often investigated for its costs and its implication for the quality of life of caregivers, it is also important to detect its impact on patients’ access and use of healthcare services. Our results suggest that caregivers facilitate or even promote the access to healthcare, especially rehabilitation services.

Key Terms

informal care, stroke, cost of illness, post acute care.

Authors:

Giovanni Fattore (Bocconi University. IAM) , Alessandra Susi (Bocconi University. IAM) and Aleksandra Torbica (Bocconi University. IAM)

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