{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T22:42:24Z","timestamp":1782168144144,"version":"3.54.5"},"reference-count":13,"publisher":"BMJ","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Qual Health Care"],"published-print":{"date-parts":[[1993,12]]},"abstract":"<jats:p>OBJECTIVES--To describe the use of care before and after stroke and to evaluate equity in access to health care services after stroke. DESIGN--Cross sectional study. SETTING--The Netherlands. PATIENTS--382 patients living in the community who had been admitted to hospital with a stroke six months before. MAIN MEASURES--Sociodemographic status and functional health status according to The Barthel index, Rankin scale, and sickness impact profile, assessed during interview, and general practitioner (GP) characteristics obtained by postal questionnaire. Univariate and multivariate analyses of the relation between patient and GP related factors and use of care. RESULTS--Compared with the period before stroke the use of care six months after stroke increased significantly, especially use of physical therapy, home help, and aids. Multivariate analyses showed that impaired functional health increased the use of care (range in odds ratios 1.6 to 6.7). Compared with younger patients, elderly patients were more likely to have home help (odds ratio 2.9) and aids (2.4) but less likely to receive therapy (0.4), psychosocial support (0.5), and an appreciable amount of care (0.5). Being female (1.7), living alone (4.0), and whether the GP was informed about patients' discharge (2.2) increased the use of home help. Higher financial income (2.8) and having a male GP (3.2) contributed to use of therapy. Emotional distress (1.6), living protected (3.2), and living alone (1.7) accounted for psychosocial support. CONCLUSIONS--Although older age, lower income, and poor discharge information to the GP decreased the use of some types of care, there is equity in access to care after stroke, primarily determined by needs in terms of functional health status and predisposing factors such as living arrangement and social circumstances. IMPLICATIONS--Patient oriented studies focusing on care processes and care outcomes in terms of subjective needs, perceived care deficits, and satisfaction with care are still required.<\/jats:p>","DOI":"10.1136\/qshc.2.4.222","type":"journal-article","created":{"date-parts":[[2008,9,29]],"date-time":"2008-09-29T13:52:26Z","timestamp":1222696346000},"page":"222-227","source":"Crossref","is-referenced-by-count":29,"title":["Use of health care services after stroke."],"prefix":"10.1136","volume":"2","author":[{"given":"R","family":"de Haan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Limburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"van der Meulen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G A","family":"van den Bos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1993,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1161\/01.STR.13.5.629","article-title":"Incidence, initial clinical picture and medical care, and three week case fatality","volume":"13","year":"1982","unstructured":"Incidence, initial clinical picture and medical care, and three week case fatality. 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Cambridge: Ballinger, 1975."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3109\/09638288809164105","article-title":"The Barthel ADL index: a standard measure of physical disability?","volume":"10","author":"Wade, D.T.; Collin, C.","year":"1988","unstructured":"Wade DT, Collin C. The Barthel ADL index: a standard measure of physical disability? International Disability Studies 1988;10:64-7.","journal-title":"International Disability Studies"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1161\/01.STR.20.6.828","article-title":"Interobserver agreement for the assessment of handicap in stroke patients (letter)","volume":"20","author":"Bamford, J.M.; Sandercock, P.A.G.; Warlow, C.P.; Slattery, XX","year":"1989","unstructured":"Bamford JM, Sandercock PAG, Warlow CP, Slattery XX. Interobserver agreement for the assessment of handicap in stroke patients (letter). Stroke 1989;20:828.","journal-title":"Stroke"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1097\/00005650-198108000-00001","article-title":"The sickness impact profile: development and final revision of a health status measure","volume":"19","author":"Bergner, M.; Bobbitt, R.A.; Carter, W.B.; Gilson, B.S.","year":"1981","unstructured":"Bergner M, Bobbitt RA, Carter WB, Gilson BS. The sickness impact profile: development and final revision of a health status measure. Med Care 1981;19:787-805.","journal-title":"Med Care"},{"key":"ref_9","article-title":"Socio-economic inequalities in the burden of chronic diseases and the use of health care. Part 4","author":"den Bos GAM, Van; ME, Lenoir","year":"1992","unstructured":"Van den Bos GAM, Lenoir ME. Socio-economic inequalities in the burden of chronic diseases and the use of health care. Part 4. Netherlands: Department of Welfare, Public Health, and Culture, 1992."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1097\/00005650-198505000-00009","article-title":"Patterns of utilization: the patient perspective","volume":"23","author":"Hulka, B.; Wheat, J.","year":"1985","unstructured":"Hulka B, Wheat J. Patterns of utilization: the patient perspective. Med Care 1985;23:438-60.","journal-title":"Med Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00005650-199001000-00006","article-title":"Individual correlates of health service utilization and the costs of poor adjustment to chronic illness","volume":"28","author":"Browne, G.B.; Arpin, K.; Corvey, P.; Glitch, M.; Gafni, A.","year":"1990","unstructured":"Browne GB, Arpin K, Corvey P, Glitch M, Gafni A. Individual correlates of health service utilization and the costs of poor adjustment to chronic illness. Med Care 1990;28:43-58.","journal-title":"Med Care"},{"key":"ref_12","first-page":"132","article-title":"The aging of the population and health services","volume":"468","author":"Vladeck, B.C.; Firman, J.P.","year":"1983","unstructured":"Vladeck BC, Firman JP. The aging of the population and health services. Annals of Health Care Policy in America 1983;468: 132-48.","journal-title":"Annals of Health Care Policy in America"},{"key":"ref_13","first-page":"421","article-title":"The use of formal and informal home care by the disabled elderly","volume":"4","author":"Kemper, P.","year":"1992","unstructured":"Kemper P. The use of formal and informal home care by the disabled elderly. Health Serv Res 1992;4:421-51.","journal-title":"Health Serv Res"}],"container-title":["Quality in Health Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/qshc.2.4.222","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T20:37:42Z","timestamp":1757018262000},"score":1,"resource":{"primary":{"URL":"https:\/\/qualitysafety.bmj.com\/lookup\/doi\/10.1136\/qshc.2.4.222"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1993,12]]},"references-count":13,"journal-issue":{"issue":"4","published-online":{"date-parts":[[1993,12,1]]},"published-print":{"date-parts":[[1993,12]]}},"alternative-id":["10.1136\/qshc.2.4.222"],"URL":"https:\/\/doi.org\/10.1136\/qshc.2.4.222","relation":{},"ISSN":["0963-8172","1475-3901"],"issn-type":[{"value":"0963-8172","type":"print"},{"value":"1475-3901","type":"electronic"}],"subject":[],"published":{"date-parts":[[1993,12]]}}}