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Money is Brain: Financial Barriers and Consequences for Canadian Stroke Patients

  • Aravind Ganesh (a1) (a2), Kathryn King-Shier (a3), Braden J. Manns (a4), Michael D. Hill (a5) (a6) and David J.T. Campbell (a7)...

Abstract

Background: Stroke patients of lower socioeconomic status have worse outcomes. It remains poorly understood whether this is due to illness severity or personal or health system barriers. We explored the experiences of stroke patients with financial barriers in a qualitative descriptive pilot study, seeking to capture perceived challenges that interfere with their poststroke health and recovery. Methods: We interviewed six adults with a history of stroke and financial barriers in Alberta, Canada, inquiring about their: (1) experiences after stroke; (2) experience of financial barriers; (3) perceived reasons for financial barriers; (4) health consequences of financial barriers; and (5) mechanisms for coping with financial barriers. Two reviewers analyzed data using inductive thematic analysis. Results: The participants developed new or worsened financial circumstances as a consequence of stroke-related disability. Poststroke impairments and financial barriers took a toll on their mental health. They struggled to access several aspects of long-term poststroke care, including allied health professional services, medications, and proper nutrition. They described opportunity costs and tradeoffs when accessing health services. In several cases, they were unaware of health resources available to them and were hesitant to disclose their struggles to their physicians and even their families. Conclusion: Some patients with financial barriers perceive challenges to accessing various aspects of poststroke care. They may have inadequate knowledge of resources available to them and may not disclose their concerns to their health care team. This suggests that providers themselves might consider asking stroke patients about financial barriers to optimize their long-term poststroke care.

Votre argent, votre cerveau : les obstacles financiers et les conséquences auxquels font face les patients canadiens victimes d’un AVC. Contexte: Les patients de statut socioéconomique inférieur victimes d’un AVC se distinguent par de moins bons pronostics de réadaptation. On comprend encore mal si cela est attribuable à la gravité de leur affection ou bien à des obstacles financiers personnels ou liés aux systèmes de santé. Dans le cadre d’une étude pilote qualitative de nature descriptive, nous avons ainsi voulu nous pencher sur les cas de patients victimes d’un AVC faisant face à des obstacles financiers. À cet égard, nous avons cherché à comprendre les difficultés qu’ils perçoivent et qui sont susceptibles de nuire à leur santé et à leur récupération post-AVC. Méthodes: Nous avons interviewé six adultes albertains (Canada) ayant des antécédents d’AVC et faisant face à des obstacles financiers. Nous avons cherché à nous enquérir de : (1) leurs expériences à la suite de leur AVC ; (2) de leur vécu en lien avec leurs obstacles financiers ; (3) des raisons qui, selon eux, expliquaient ces obstacles ; (4) des conséquences de ces obstacles sur leur santé ; (5) et des moyens à leur portée pour y faire face. Deux évaluateurs se sont ensuite penchés sur ces données au moyen d’une analyse thématique par raisonnement inductif. Résultats: Au dire des participants, ils ont commencé à éprouver des difficultés financières ou ont vu ces dernières s’aggraver en raison de l’invalidité consécutive à leur AVC. Leurs troubles post-AVC et leurs obstacles financiers ont aussi eu de graves répercussions sur leur santé mentale. Ils ont dû se démener pour avoir accès à des soins de longue durée post-AVC, ce qui inclut des services de santé connexes, des médicaments et une alimentation adéquate. Ils ont aussi décrit le manque à gagner et les compromis financiers au moment d’avoir accès à des services de santé. Dans bien des cas, ils ignoraient l’existence de ressources à leur disposition et étaient réticents à révéler leurs difficultés à leurs médecins et même à leurs familles. Conclusions: Certains patients aux prises avec des obstacles financiers considèrent l’accès à des soins post-AVC comme un défi. Il est possible qu’ils possèdent une connaissance réduite des ressources à leur disposition et qu’ils ne fassent pas part de leurs préoccupations à leur équipe soignante. Cela nous porte à croire que les dispensateurs de soins devraient eux-mêmes envisager de questionner les patients victimes d’un AVC au sujet de ces obstacles financiers, et ce, afin d’optimiser les soins de longue durée post-AVC leur étant prodigués.

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Copyright

Corresponding author

Correspondence to: David J.T. Campbell, Cumming School of Medicine Departments of Medicine and Community Health Sciences, University of Calgary, Health Sciences Centre, Room G236. 3330 Hospital Dr NW, Calgary, Alberta, Canada, T2N 4N1. Email: dcampbel@ucalgary.ca

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Keywords

Money is Brain: Financial Barriers and Consequences for Canadian Stroke Patients

  • Aravind Ganesh (a1) (a2), Kathryn King-Shier (a3), Braden J. Manns (a4), Michael D. Hill (a5) (a6) and David J.T. Campbell (a7)...

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