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Evaluation of Ischemic Stroke-Related Healthcare Utilization Trends Using Recent National Data: 2000 – 2005

Karve, Sudeep
http://rave.ohiolink.edu/etdc/view?acc_num=osu1242827395

Abstract Details

2009, Doctor of Philosophy, Ohio State University, Pharmacy.
Despite stable incidence rate, recent studies have reported a decline in ischemic stroke (IS) related inpatient admissions. However, there has been no known reason for this decline in IS-related inpatient admissions. Concurrent information on IS-related ambulatory utilization was thus needed to assess a shift in management of IS patients from an inpatient to ambulatory setting. Thus, the primary objective of this study was to assess temporal trends in IS-related ambulatory (physician office, hospital outpatient, and hospital emergency department) and inpatient utilization using the National Ambulatory Medical Care Survey (NAMCS), National Hospital Ambulatory Medical Care Survey (NHAMCS) and Health Care Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) for the years 2000 through 2005. Secondly, the supply of ambulatory primary care physicians and neurologists available to provide IS-related care has not been evaluated. Given increasing stroke prevalence, the adequacy of the physician supply of primary care physicians, cardiovascular physicians, and neurologists to provide chronic care to these complex ambulatory IS patients at high-risk for cardiovascular events and stroke complications has been questioned. Thus, the second objective of this study was to assess temporal trends in IS-related outpatient utilization by physician specialty using the National Ambulatory Medical Care Survey (NAMCS) for the years 2000 through 2005. Finally, anti-platelet drugs are recommended among ischemic stroke (IS) patients to reduce the risk of recurrent stroke. However, there are inadequate efficacy and safety data comparing these drugs in preventing recurrent ischemic stroke to guide physicians in choice of drug. Factors other than evidence-based medicine such as clinical judgment, pharmaceutical marketing, and local opinion leaders, may influence physicians choice of a specific anti-platelet drug for secondary stroke prevention. Thus, the third objective of our study was to assess the temporal trends in prescribing of anti-platelet agents among patients with IS seeking ambulatory care using the National Ambulatory Medical Care Survey (NAMCS), National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 2000 through 2005. The primary finding of this study was that during the 6-year period, IS-related inpatient admissions have steadily declined with a subsequent gradual increase in IS-related ambulatory utilization. The increased proportion of patients presenting at physician offices with acute IS, suggests a probable shift in management of IS patients from the inpatient to the outpatient setting. The increased in physician office utilization will require additional resource in order to provide appropriate quality of care to these complex ambulatory IS patients. Increased outpatient IS utilization has lead to increased (number or frequency) of visits to the neurologist for IS. Compared to the year 2000, the number of IS-related visits to the neurologist increased by 126% whereas the number of neurologists providing stroke care increased by 21% by 2005. Our data suggest that an increased supply of neurologists providing stroke care in the ambulatory setting is needed and will be needed in future years if stroke prevalence rates remain stable or increase. Finally, in our study we identified that the proportion of IS patients receiving anti-platelet therapy remained low in the range of 28 to 38%. Despite the lack of adequate efficacy and safety data, the proportion of IS-patients receiving the clopidogrel-aspirin combination, a combination recently shown to lack efficacy and cause harm in preventing recurrent stroke, increased significantly from 2000 to 2005. Quality improvement measures are warranted to educate physicians of the evidence regarding anti-platelet drugs for secondary stroke prevention and improve prescribing of safe anti-platelet drugs among IS patients.
Rajesh Balkrishnan, PhD (Advisor)
Deborah Levine, MD (Committee Co-Chair)
Milap Nahata, MS (Committee Member)
Eric Seiber, PhD (Committee Member)
Health Care
Stroke; Ambulatory; Inpatient; Utilization

Recommended Citations

Citations

  • Karve, S. (2009). Evaluation of Ischemic Stroke-Related Healthcare Utilization Trends Using Recent National Data: 2000 – 2005 [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1242827395

    APA Style (7th edition)

  • Karve, Sudeep. Evaluation of Ischemic Stroke-Related Healthcare Utilization Trends Using Recent National Data: 2000 – 2005. 2009. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1242827395.

    MLA Style (8th edition)

  • Karve, Sudeep. "Evaluation of Ischemic Stroke-Related Healthcare Utilization Trends Using Recent National Data: 2000 – 2005." Doctoral dissertation, Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=osu1242827395

    Chicago Manual of Style (17th edition)

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This open access ETD is published by The Ohio State University and OhioLINK.