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Training of care givers after stroke reduces costs

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Improvements in stroke rehabilitation have increased the number of disabled patients who live at home with the help of untrained care givers. Trying to help care givers by providing information packages, family support workers, or specialist nurses has provided only modest benefits for patients and carers. Now researchers in London, UK have shown that caregiver training is beneficial and reduces service costs.

The care givers of 300 stroke patients on a stroke rehabilitation unit were randomised, before the patient went home, to training in basic nursing, moving, handling, and assistance with activities of daily living and communication (three to five 30–45 minute sessions on the unit and one follow up session at home) or no training. All received conventional advice, information, and involvement. Caregivers who received training had better mental health and quality of life at three and 12 months and the patients’ quality of life also improved.

The economic evaluation included health services, other formal care agencies, and informal carers and cost per patient was calculated from unit costs and resource volumes. Health and social costs over one year at 2001–2002 prices were £10544 (caregiver training) v £14587 (no training), a saving of £4043 (US $7249, € 6072). With inclusion of informal care costs the total saving was £4091. Most of the saving was due to shorter initial hospital stay in the caregiver training group rather than cost reductions in care whilst at home. The costs of informal care were similar in the two groups so there was no shifting of costs from statutory services to care givers. No change in caregivers’ quality adjusted life years was detected using the EuroQol five-dimensional questionnaire (EQ-5D).

Providing training for caregivers of stroke patients improves their quality of life, as well as that of the patients, and reduces service costs, largely by expediting discharge from hospital.