Depressed stroke patients use more health services

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After having a stroke, healthcare utilization is significantly higher among patients who develop poststroke depression than those who are not depressed, according to findings published in the medical journal Stroke.

“Poststroke depression is common among stroke survivors, and it is associated with worse functional outcomes and increased poststroke mortality,” Dr. Huanguang Jia, from the VA Medical Center, Gainesville, Florida, and colleagues write. “Limited information is available about its impact on healthcare use.”

In a national study, the researchers evaluated the impact of poststroke depression on healthcare use by 5,825 veterans with identified from VA inpatient databases. The team used VA and Medicare inpatient and outpatient data, and VA pharmacy information, to determine the subjects’ poststroke depression status and healthcare use.

Patients were considered to have poststroke depression if they had a diagnosis of depression or if they were prescribed an antidepressant within 12 months after the stroke. Healthcare use was defined as the number of hospital stays, outpatient visits, and the cumulative length of inpatient stays.

The investigators report that 41 percent of the patients had poststroke depression. Compared with subjects without poststroke depression, those with poststroke depression had significantly more inpatient stays (2.4 versus 1.8) and outpatient visits (30.7 versus 20.0). Patients with poststroke depression also had a longer average length of inpatient stays (25.0 versus 17.9).

These associations remained after accounting for the effect of the patients’ demographic factors and other health factors.

“More specifically, we estimated that patients with poststroke depression had inpatient stays 1.2 times, outpatient visits 1.3 times, and length of stays 1.4 times that of the patients without poststroke depression, respectively, within the first 12 months of the...stroke,” Jia and colleagues report.

They conclude that early identification and treatment of poststroke depression may help “reduce overall cost of care, prevent premature deaths, and improve functional recovery and quality of life.”

SOURCE: Stroke, November 2006.

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