Oral Presentation Smart Strokes Annual Scientific Meeting 2024

Unmet needs after discharge: results from the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. (106797)

Dominique A Cadilhac 1 2 , Jan Cameron 1 , Olivia Brancatisano 1 , Monique F Kilkenny 1 2 , Ian Kneebone 3 , Nadine E Andrew 4 5 , Avril Drummond 6 , Muideen Olaiya 1 , Catherine Burns 1 , Amanda G Thrift 1 , Sandy Middleton 7 8 , Geoffrey Cloud 9 10 , Henry Ma 1 , Maree Hackett 11 , Rohan Grimley 12 , Vincent Thijs 2 , Natasha A Lannin 9 10
  1. Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  2. Stroke theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
  3. Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
  4. Peninsula Clinical School, School of Translational Medicine, Monash University, Frankston, Victoria, Australia
  5. National Centre for Healthy Ageing, Frankston, Victoria, Australia
  6. Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
  7. Nursing Research Institute, St Vincent's Health Network, Sydney, NSW, Australia
  8. Australian Catholic University, Sydney, NSW, Australia
  9. Department of Neurosciences, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
  10. Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
  11. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Barangaroo, NSW, Australia
  12. Sunshine Coast Clinical School, Griffith University, Birtinya, QLD, Australia

Introduction: Factors influencing the early unmet needs of people with stroke discharged to the community are unclear, and if unmet needs remain ongoing issues. Aims: To describe factors associated with unmet needs 7-14 days after discharge following acute stroke, and to describe prioritised goals to address unmet needs and if these are achieved by 90 days.

Methods: We used aggregated data from the 466 ReCAPS trial participants recruited from 9 Australian hospitals.  Participants identified 2-5 health and recovery goals at baseline, prioritised using a structured menu-based, goal-setting approach ensuring goals were realistic, measurable and time-bound. Discharge satisfaction (PREPARED survey) and the Long-term Unmet Needs Survey (LUNS) were obtained by phone 7-14 days post discharge. At 90-days, the LUNS and goal attainment were re-assessed. Patient characteristics and 90-day outcomes were summarised using descriptive statistics. Changes from baseline to 90-days were tested using McNemar’s chi-square test, Kruskal-Wallis test or univariable ordered logistic regression.

Results: Participants (median age 67 years, 33% female) reported a mean 2.6 unmet needs at baseline compared with 1.5 at 90-days; frequency at baseline differed by age, sex, length of stay, level of dependency, confidence to manage at home or feeling prepared to return home. Sixteen participants (3%) felt unprepared to return home and this group had more unmet needs: (7.1) than 77% who felt very prepared (2.2; p <0.01). Various unmet needs were reported although most improved significantly by 90-days. For example, 80% of health-related goals and 78% of everyday activities goals were partially or fully met. 

Conclusion: Various factors influenced unmet needs within 7-14 days of returning home after an acute stroke, including preparation for discharge.

Relevance to clinical practice: Our results highlight the importance of preparing patients for discharge. If feasible, it might be beneficial to ‘check-in’ with patients early after discharge to discuss unmet needs.