Neuroepidemiology · 2025
General Practitioner Coordinated Multidisciplinary Care Improves Long-Term Survival following Stroke with Variation by Impairment.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Andrew Nadine E, Ung David, Kilkenny Monique F, Olaiya Muideen T, Dalli Lachlan L, Churilov Leonid, Collyer Taya, Snowdon David A, Kim Joosup, Srikanth Velandai, Cadilhac Dominique A, Sundararajan Vijaya, Thrift Amanda G, Nelson Mark R, Lannin Natasha A
Аннотация
UNLABELLED: <p>Background: Australian Medicare funded policies to support General Practtitioners (GPs) to coordinate multidisciplinary care (MDC) with other healthcare providers have potential to benefit survivors of stroke/transient ischaemic attack (TIA). However, the effectiveness of these policies is unknown. We aimed to determine the population effect of such policies in improving long-term outcomes following stroke/TIA, by impairment grouping.
METHODS: Target trial emulation using observational data within a cohort of community-dwelling adults with stroke/TIA from the Australian Stroke Clinical Registry (January 2012-December 2016, 42 hospitals). Person-level Medicare, pharmacy, aged care, death, and hospital records were linked. The exposure was ≥1 Medicare GP-MDC claim 6-18 months post-stroke. Outcomes were survival and hospitalisations at 19-30 months. Impairment group (minimal, moderate, severe) was classified by latent class analysis of EQ-5D-3L questionnaire data obtained 90-180 days post-stroke. Analysis comprised multivariable, multilevel survival analysis with inverse probability treatment weights (42 covariates).
RESULTS: The cohort comprised 7,255 people with stroke (42% female, median age 71 years, 24% TIA, impairment: 39% minimal, 32% moderate, 29% severe, 29% had a MDC claim). More claims occurred with each increasing level of impairment group: minimal 22%; moderate 30%; severe 37%. Twelve-month mortality was reduced in those with ≥1 MDC claim (compared to those without) in the minimal (adjusted hazard ratio [aHR]: 0.50, 95% CI: 0.27, 0.91) and severe (aHR: 0.65, 95% CI: 0.46, 0.91) impairment groups, but not in the moderate group (aHR: 1.31, 95% CI: 0.86, 1.99). Compared to those without a claim, hospital presentations were greater in the minimal (aHR: 1.30, 95% CI: 1.06, 1.59) and moderate impairment groups (aHR: 1.40, 95% CI: 1.23, 1.60) but not the severe group (aHR: 1.05, 95% CI: 0.85, 1.30).
CONCLUSIONS: Government policy incentives for GP-coordinated MDC were effective at the population level at improving long-term survival outcomes, in those with minimal and severe impairments. </p>.
METHODS: Target trial emulation using observational data within a cohort of community-dwelling adults with stroke/TIA from the Australian Stroke Clinical Registry (January 2012-December 2016, 42 hospitals). Person-level Medicare, pharmacy, aged care, death, and hospital records were linked. The exposure was ≥1 Medicare GP-MDC claim 6-18 months post-stroke. Outcomes were survival and hospitalisations at 19-30 months. Impairment group (minimal, moderate, severe) was classified by latent class analysis of EQ-5D-3L questionnaire data obtained 90-180 days post-stroke. Analysis comprised multivariable, multilevel survival analysis with inverse probability treatment weights (42 covariates).
RESULTS: The cohort comprised 7,255 people with stroke (42% female, median age 71 years, 24% TIA, impairment: 39% minimal, 32% moderate, 29% severe, 29% had a MDC claim). More claims occurred with each increasing level of impairment group: minimal 22%; moderate 30%; severe 37%. Twelve-month mortality was reduced in those with ≥1 MDC claim (compared to those without) in the minimal (adjusted hazard ratio [aHR]: 0.50, 95% CI: 0.27, 0.91) and severe (aHR: 0.65, 95% CI: 0.46, 0.91) impairment groups, but not in the moderate group (aHR: 1.31, 95% CI: 0.86, 1.99). Compared to those without a claim, hospital presentations were greater in the minimal (aHR: 1.30, 95% CI: 1.06, 1.59) and moderate impairment groups (aHR: 1.40, 95% CI: 1.23, 1.60) but not the severe group (aHR: 1.05, 95% CI: 0.85, 1.30).
CONCLUSIONS: Government policy incentives for GP-coordinated MDC were effective at the population level at improving long-term survival outcomes, in those with minimal and severe impairments. </p>.