Are patients afraid to go home? Disposition preferences after transient ischaemic attack and minor stroke.
neurology
patient support
psychology
stroke
Journal
Emergency medicine journal : EMJ
ISSN: 1472-0213
Titre abrégé: Emerg Med J
Pays: England
ID NLM: 100963089
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
29
09
2019
revised:
07
01
2020
accepted:
10
01
2020
pubmed:
30
1
2020
medline:
30
3
2021
entrez:
30
1
2020
Statut:
ppublish
Résumé
Recent evidence suggests clinical equipoise for managing transient ischaemic attack and minor stroke (TIAMS) either via discharge from the emergency department (ED) with rapid outpatient follow-up or inpatient admission. Understanding patient preferences may guide decision-making around disposition after TIAMS that can lead to higher patient satisfaction and adherence. Psychological distress, particularly a sense of vulnerability (eg, 'threat perception') is associated with adverse psychological outcomes following TIAMS and may influence patient disposition preference. We hypothesised patients with higher threat perceptions in the ED would prefer inpatient admission versus early discharge with rapid outpatient follow-up. This was a planned secondary analysis of a prospective observational cohort study of ED patients with suspected TIAMS (defined as National Institutes of Health Stroke Scale (NIHSS) score of ≤5). Patients reported disposition preferences and completed a validated scale of threat perception while in the ED (score range: 1-4). 147 TIAMS patients were evaluated (mean age: 59.7±15.4, 45.6% female, 39.5% Hispanic, median NIHSS=1, IQR: 0, 3). A majority of patients (98, 66.7%) preferred inpatient admission compared with discharge from the ED. Overall threat scores were median 1.0 (IQR: 0.43, 1.68). Those preferring admission had similar threat scores compared with those who preferred early disposition (median: 1.00, IQR: 0.43, 1.57) versus 1.00, (IQR: 0.49, 1.68); p=0.40). In a model adjusted for demographic characteristics, threat perceptions remained unassociated with disposition preference. Overall, two-thirds of TIAMS patients preferred inpatient admission over discharge. Disposition preference was not associated with higher threat perception in the ED. Further research examining potential drivers of patient disposition preferences may inform patient discussions and optimise patient satisfaction.
Sections du résumé
BACKGROUND
BACKGROUND
Recent evidence suggests clinical equipoise for managing transient ischaemic attack and minor stroke (TIAMS) either via discharge from the emergency department (ED) with rapid outpatient follow-up or inpatient admission. Understanding patient preferences may guide decision-making around disposition after TIAMS that can lead to higher patient satisfaction and adherence. Psychological distress, particularly a sense of vulnerability (eg, 'threat perception') is associated with adverse psychological outcomes following TIAMS and may influence patient disposition preference. We hypothesised patients with higher threat perceptions in the ED would prefer inpatient admission versus early discharge with rapid outpatient follow-up.
METHODS
METHODS
This was a planned secondary analysis of a prospective observational cohort study of ED patients with suspected TIAMS (defined as National Institutes of Health Stroke Scale (NIHSS) score of ≤5). Patients reported disposition preferences and completed a validated scale of threat perception while in the ED (score range: 1-4).
RESULTS
RESULTS
147 TIAMS patients were evaluated (mean age: 59.7±15.4, 45.6% female, 39.5% Hispanic, median NIHSS=1, IQR: 0, 3). A majority of patients (98, 66.7%) preferred inpatient admission compared with discharge from the ED. Overall threat scores were median 1.0 (IQR: 0.43, 1.68). Those preferring admission had similar threat scores compared with those who preferred early disposition (median: 1.00, IQR: 0.43, 1.57) versus 1.00, (IQR: 0.49, 1.68); p=0.40). In a model adjusted for demographic characteristics, threat perceptions remained unassociated with disposition preference.
CONCLUSION
CONCLUSIONS
Overall, two-thirds of TIAMS patients preferred inpatient admission over discharge. Disposition preference was not associated with higher threat perception in the ED. Further research examining potential drivers of patient disposition preferences may inform patient discussions and optimise patient satisfaction.
Identifiants
pubmed: 31992569
pii: emermed-2019-209154
doi: 10.1136/emermed-2019-209154
pmc: PMC7384925
mid: NIHMS1591413
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
486-488Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL132347
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL141811
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL146911
Pays : United States
Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Psychiatr Serv. 2013 Dec 1;64(12):1195-202
pubmed: 24036589
J Emerg Med. 2018 May;54(5):636-644
pubmed: 29321107
Circulation. 2016 Jan 26;133(4):447-54
pubmed: 26811276
J Health Psychol. 2019 Nov;24(13):1817-1827
pubmed: 28810445
Am J Emerg Med. 2018 Jan;36(1):156-158
pubmed: 28711276
PLoS One. 2012;7(6):e38915
pubmed: 22745687
Gen Hosp Psychiatry. 2019 Sep - Oct;60:83-89
pubmed: 31376645
Ann Emerg Med. 2019 Oct;74(4):562-571
pubmed: 31326206
Acad Emerg Med. 2018 Oct;25(10):1098-1106
pubmed: 29972892
Lancet Neurol. 2007 Nov;6(11):953-60
pubmed: 17928270