Returning home after a stroke may go better with a support network involving social work case managers and online resources, research finds.

As reported in Circulation: Cardiovascular Quality and Outcomes, researchers developed the Michigan Stroke Transitions Trial and tested three different support strategies involving 265 recovering stroke patients and 169 caregivers to see which worked best for the hospital-to-home transition.

The study began with a series of focus groups conducted before the clinical trial where researchers asked stroke patients and caregivers about what worried them most.

“Many of the participants said they left the hospital not really knowing what to do when they got home,” says coauthor Michele Fritz, an epidemiologist who worked with lead author Mat Reeves in the epidemiology and biostatistics department at Michigan State University.

ANXIETY AND WORRY
According to Fritz, 72 percent of stroke patients felt unprepared to go home, 91 percent were worried about having another stroke, and 82 percent didn’t fully understand their medications, such as when to take them and what dosage they needed.

“This caused a lot of anxiety and worry,” Fritz says. “These patients get great care when they’re in the hospital, but once they get home, they’re often lost. It was important for us to really understand what mattered to them and then figure out what kind of support structure could alleviate the worry.”

Researchers chose participants at random to receive the usual post-hospital care that exists today, including leaving the hospital with standard stroke education materials, follow-up medical information, and referrals to outpatient doctor visits and rehabilitation services, if needed.

They randomly assigned another group a social work case manager who offered emotional and practical support for up to 90 days after leaving the hospital. The remaining group of participants had access to the same case manager but also had access to a patient website.

DEPRESSION STRUGGLES
The website offered unlimited access to stroke education and support resources, including information on stroke prevention and recovery, useful tips to manage medications, and information on community-based services and resources.

In total, 160 patients worked with a social work case manager. The three most common concerns included:

Nearly 70 percent needed additional information about stroke.
More than half wanted help understanding how to prevent another stroke.
Slightly more than one-third had financial concerns.
Patients with a case manager and the website reported significantly greater improvements in physical health by the end of the study compared to those who had the traditional care. They also said they were more confident in taking control of their care. Those with access only to the case manager also reported some improvements but results were not as strong.

“When you add the website into the mix, we have better results,” Fritz says.

Some patients still struggled with depression, regardless of what support program they received, Fritz says.

“This is an area we need to look further into. It could mean we need more time to improve participants’ mental health. It’s all complex to measure, but something we will continue to figure out in future studies.”

The Patient-Centered Outcomes Research Institute funded the work.

Source: Michigan State University

Original Study DOI: 10.1161/CIRCOUTCOMES.119.005493