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Secondary prevention after stroke/transient ischemic attack: A randomized audit and feedback trial
Lukas Geary1,2,3, Jan Hasselström4,5, Axel Carl Carlsson4
1Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden.
Acta Neurologica Scandinavica
|April 25, 2019
Summary
An audit and feedback intervention did not improve medication use for secondary stroke prevention in primary care. Future interventions should use continuous reminders and patient engagement for better adherence to stroke prevention guidelines.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- Secondary preventive pharmacotherapy significantly benefits patients with ischemic stroke or transient ischemic attack (TIA).
- Primary care physicians are a key target for improving the uptake of recommended secondary stroke prevention medications.
Purpose of the Study:
- To assess the impact of an audit and feedback intervention on secondary preventive medication use and diagnosis recording in primary care for ischemic stroke/TIA patients.
- To evaluate the effectiveness of quality reports in enhancing adherence to secondary stroke prevention guidelines.
Main Methods:
- An audit and feedback intervention involving structured quality reports was implemented in half of Stockholm County's primary care centers.
- Medication dispensation (statins, antihypertensives, antiplatelets, anticoagulants) and diagnosis recording were compared between intervention and control centers over 18 months post-intervention.
- Data were sourced from the Stockholm County healthcare databases (VAL).
Main Results:
- Baseline medication dispensation was already high, with over 77% of patients using antihypertensives and antithrombotics, and 65%-68% using statins.
- The audit and feedback intervention did not result in statistically significant differences in medication dispensation between intervention and control groups after 18 months.
- No improvement in diagnosis recording was observed between the groups following the intervention.
Conclusions:
- A straightforward audit and feedback intervention in primary care did not enhance medication dispensation for secondary stroke prevention 18 months later.
- Future interventions should incorporate continuous, multi-faceted reminders and patient involvement to improve adherence to secondary stroke prevention guidelines.
- Enhancing the graphical presentation of feedback reports may also be crucial for intervention effectiveness.
Keywords:
diagnosis recordingdrug therapygeneral practitionersphysiciansprimary careprimary health caresecondary preventionstroketransient ischemic attackMore Related Videos
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