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DOES SUPPLEMENTAL HEALTH INSURANCE AFFECT THROMBOLYSIS RATE IN ACUTE STROKE?

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ESOC-2019

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Abstract

INTRODUCTION Thrombolysis for acute ischaemic stroke has been widely available in Ireland since 2007. Although all patients are eligible for free emergency hospital treatment, 45.4% of the Irish population carry supplemental health insurance. All stroke patients presenting to emergency departments are managed by the same thrombolysis pathway, regardless of insurance status. We examined if patients with supplemental health insurance present more frequently within window for thrombolysis, potentially indicative of increased health concern or education in this population. METHODS A retrospective analysis was carried out on admissions to a tertiary University Hospital, between 01/01/2013 and 30/06/2017, of patients coded as ‘stroke’ on the hospital electronic stroke register. The health insurance status of all thrombolysed strokes were compared to age and sex-matched controls at a ratio of 1:2, and to the entire register population, to analyse demographic factors. RESULTS 189 patients were thrombolysed between 1/1/2013 and 30/6/2017, of a total 1,333 strokes (14.2%). The average age of the thrombolysis group was 73, while the average age of the entire stroke population was 70.1 (p=0.008, t test). Insured patients were thrombolysed more frequently (28% v 24%) but this was not statistically significant (X2=0.91, p=0.34). There was no significant difference in the male:female ratio between thrombolysed and non-thrombolysed groups (52.4 % vs. 55.4% males), (X2=0.6, p=0.44). CONCLUSION Patients presenting to St James’ Hospital, with supplemental health insurance, are not more likely to get thrombolysis compared to patients without. Overall, the thrombolysis group were significantly older, but there was no difference between the sexes.

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