Monique F Kilkenny1, Natasha A Lannin2, Craig S Anderson2, Helen M Dewey2, Joosup Kim2, Karen Barclay-Moss2, Chris Levi2, Steven Faux2, Kelvin Hill2, Brenda Grabsch2, Sandy Middleton2, Amanda G Thrift2, Rohan Grimley2, Geoffrey Donnan2, Dominique A Cadilhac2. 1. From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.). monique.kilkenny@monash.edu. 2. From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.).
Abstract
BACKGROUND AND PURPOSE: In multicultural Australia, some patients with stroke cannot fully understand, or speak, English. Language barriers may reduce quality of care and consequent outcomes after stroke, yet little has been reported empirically. METHODS: An observational study of patients with stroke or transient ischemic attack (2010-2015) captured from 45 hospitals participating in the Australian Stroke Clinical Registry. The use of interpreters in hospitals, which is routinely documented, was used as a proxy for severe language barriers. Health-Related Quality of Life was assessed using the EuroQoL-5 dimension-3 level measured 90 to 180 days after stroke. Logistic regression was undertaken to assess the association between domains of EuroQoL-5 dimension and interpreter status. RESULTS: Among 34 562 registrants, 1461 (4.2%) required an interpreter. Compared with patients without interpreters, patients requiring an interpreter were more often women (53% versus 46%; P<0.001), aged ≥75 years (68% versus 51%; P<0.001), and had greater access to stroke unit care (85% versus 78%; P<0.001). After accounting for patient characteristics and stroke severity, patients requiring interpreters had comparable discharge outcomes (eg, mortality, discharged to rehabilitation) to patients not needing interpreters. However, these patients reported poorer Health-Related Quality of Life (visual analogue scale coefficient, -9; 95% CI, -12.38, -5.62), including more problems with self-care (odds ratio: 2.22; 95% CI, 1.82, 2.72), pain (odds ratio: 1.84; 95% CI, 1.52, 2.34), anxiety or depression (odds ratio: 1.60; 95% CI, 1.33, 1.93), and usual activities (odds ratio: 1.62; 95% CI, 1.32, 2.00). CONCLUSIONS: Patients requiring interpreters reported poorer Health Related Quality of Life after stroke/transient ischemic attack despite greater access to stroke units. These findings should be interpreted with caution because we are unable to account for prestroke Health Related Quality of Life. Further research is needed.
BACKGROUND AND PURPOSE: In multicultural Australia, some patients with stroke cannot fully understand, or speak, English. Language barriers may reduce quality of care and consequent outcomes after stroke, yet little has been reported empirically. METHODS: An observational study of patients with stroke or transient ischemic attack (2010-2015) captured from 45 hospitals participating in the Australian Stroke Clinical Registry. The use of interpreters in hospitals, which is routinely documented, was used as a proxy for severe language barriers. Health-Related Quality of Life was assessed using the EuroQoL-5 dimension-3 level measured 90 to 180 days after stroke. Logistic regression was undertaken to assess the association between domains of EuroQoL-5 dimension and interpreter status. RESULTS: Among 34 562 registrants, 1461 (4.2%) required an interpreter. Compared with patients without interpreters, patients requiring an interpreter were more often women (53% versus 46%; P<0.001), aged ≥75 years (68% versus 51%; P<0.001), and had greater access to stroke unit care (85% versus 78%; P<0.001). After accounting for patient characteristics and stroke severity, patients requiring interpreters had comparable discharge outcomes (eg, mortality, discharged to rehabilitation) to patients not needing interpreters. However, these patients reported poorer Health-Related Quality of Life (visual analogue scale coefficient, -9; 95% CI, -12.38, -5.62), including more problems with self-care (odds ratio: 2.22; 95% CI, 1.82, 2.72), pain (odds ratio: 1.84; 95% CI, 1.52, 2.34), anxiety or depression (odds ratio: 1.60; 95% CI, 1.33, 1.93), and usual activities (odds ratio: 1.62; 95% CI, 1.32, 2.00). CONCLUSIONS:Patients requiring interpreters reported poorer Health Related Quality of Life after stroke/transient ischemic attack despite greater access to stroke units. These findings should be interpreted with caution because we are unable to account for prestroke Health Related Quality of Life. Further research is needed.
Authors: Thi Thu Le Pham; Janneke Berecki-Gisolf; Angela Clapperton; Kerry S O'Brien; Sara Liu; Katharine Gibson Journal: Int J Environ Res Public Health Date: 2021-01-16 Impact factor: 3.390