[Home treatment of patients with cerebrovascular accidents]

In the Netherlands one-third of stroke patients are managed at home. This study describes the characteristics of these patients and the management by the GP from stroke onset till six months afterwards.

A community based cohort of 185 stroke patients were examined at fixed intervals during 6 months poststroke; mortality and functional status of patients managed at home (n = 73) were compared with those of patients admitted to hospital (n = 109); 3 patients were directly admitted to a nursing home; characteristics of the GPs' management were registered.

Patients managed at home were somewhat older (p < 0.05), lived more often in a residential home for the elderly (p < 0.05) and were more frequently known with comorbidity such as diabetes mellitus and Alzheimer (p < 0.05). Their poststroke disabilities were less grave; mortality rate was much lower than in the hospitalised group (p < 0.05). Recovery showed the same pattern in both groups. In the acute phase the GP made frequent housecalls; after a few days there was a decline in contact frequency. The mean 'treatment duration' was 12 weeks. The amount of care provided by the GP did not correlate with stroke severity.

In the acute phase, when the patients' clinical condition was still unstable and the patients' families needed support, the GPs made frequent house-calls. During the stroke episode the number of contacts and the length of the treatment duration were defined more by comorbidity and social factors than by the severity of stroke. Regarding the pattern of stroke recovery the mean treatment duration of 12 weeks appears rather short for optimal support and rehabilitation.