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Identification of stroke in the community: a comparison of three methods
1Department of Primary Care and General Practice, University of Birmingham, Primary Care Clinical Sciences Building, Edgbaston, Birmingham B15 2TT. j.w.mant@bham.ac.uk
Insights
Identifying prevalent stroke cases is crucial for secondary prevention. General practice computer systems offer a reasonably accurate method for creating stroke registers, with patient surveys as a viable alternative.
Area of Science:
- Public Health
- Epidemiology
- Health Informatics
Background:
- Secondary prevention of cerebrovascular disease is underutilized in clinical practice.
- Accurate identification of eligible patients is a prerequisite for effective secondary prevention strategies.
- Establishing a register of prevalent stroke cases in primary care is essential.
Purpose of the Study:
- To compare the effectiveness of three methods for identifying prevalent cerebrovascular disease cases in the community.
- Methods compared include general practice computer systems, population surveys, and hospital information systems.
Main Methods:
- A comparative study involving 5801 individuals aged 65+ in South Birmingham.
- Sensitivity, specificity, and positive predictive value (PPV) of each identification method were calculated against reference criteria.
- Reference criteria were applied independently by two investigators.
Main Results:
- The prevalence of validated cerebrovascular disease in the target population was 8.2%.
- General practice computer systems showed 81.0% sensitivity and 97.2% specificity, with a 71.8% PPV, but with significant inter-practice variability.
- Patient surveys (75.7% sensitivity, 77.5% PPV) and hospital systems (28.4% sensitivity, 89.2% PPV) had different performance profiles. Notably, 39% of patients with cerebrovascular disease had no hospital admission history.
Conclusions:
- General practice-based computer systems are capable of generating accurate prevalent stroke registers.
- Patient surveys serve as a practical alternative in settings with underdeveloped primary care IT systems.
Background:
Evidence concerning secondary prevention of cerebrovascular disease is not optimally used in clinical practice. A necessary first step is to identify those eligible for treatment. In primary care, this equates to setting up a register of prevalent stroke.
Aim:
To compare three different methods for identifying prevalent cases of cerebrovascular disease in the community: general practice-based computer systems; population surveys; and hospital-based routine information systems.
Design Of Study:
Comparison of results of each method applied to a defined population and then assessed against reference criteria for cerebrovascular disease.
Setting:
A total of 5801 people aged 65 years or over, resident in seven practices situated within the South Birmingham Primary Care Trust area.
Method:
The sensitivity, specificity, and predictive value of each method of identification were calculated against reference criteria applied by two investigators independently of each other.
Results:
The prevalence of reference criteria-validated cerebrovascular disease in patients aged 65 years or over was 8.2%. Overall, general practice-based computer systems had a sensitivity of 81.0%, a specificity of 97.2% and a positive predictive value (PPV) of 71.8%, but there was a wide range of sensitivity (33% to 90%) and PPV (42% to 92%) between practices. Patient survey and hospital information systems were less sensitive (75.7% and 28.4%, respectively) but had higher PPVs (77.5% and 89.2%, respectively). Thirty-nine per cent of patients with a history of cerebrovascular disease had not been admitted to hospital.
Conclusion:
General practice-based computer systems can produce reasonably accurate prevalent stroke registers. In areas where these are poorly developed, patient survey is an alternative.