Almost all GPs (94%) managing acute stroke patients at home used aspirin, but 60% stated they aimed for acute blood pressure reduction after an acute stroke

Almost all GPs (94%) managing acute stroke patients at home used aspirin, but 60% stated they aimed for acute blood pressure reduction after an acute stroke. Over 85% of GPs reported that there was no routine liaison from hospitals during admission or leading up to discharge. stroke prevention and care. Conclusion General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care. Background Stroke is a major cause of mortality[1] and morbidity[2], and might be argued to be a chronic disease with acute events[3]. Population-based data suggest that acute cerebrovascular events are at least as common as coronary events[4]. The lifetime risk of first-ever stroke from age 55 years in the Framingham cohort was as high as 1 in 5[5]. There is considerable opportunity for primary prevention of stroke: treatments for hypertension[6,7] and non-valvular atrial fibrillation[8,9] are effective in reducing the risk of stroke, but may not be fully implemented[10]. Observational studies have shown that lifestyle factors such as diet, smoking, exercise, and alcohol intake can predict the risk of stroke [11-13], thereby supporting the adoption of lifestyle risk factor modification. The actuarial risk of recurrent stroke after a first stroke is about 30% over five years[14], and there is strong evidence of the benefits of anti-platelet therapy[15], blood pressure lowering[16] and lipid lowering[17] in secondary prevention. Despite improvements in the use of secondary prevention medication, there is further scope for achieving more from these medications[18]. General practitioners (GPs) are well placed to implement secondary prevention programmes for stroke. For instance, in an Irish study of 195 discharged stroke patients, the majority (87%) had seen their GP since hospital discharge, whereas just less than half (48%) had been reviewed in hospital outpatient departments[19]. With regard to emergency care, current guidelines recommend all patients with suspected acute stroke are immediately transferred by ambulance to a receiving hospital providing acute stroke services and organised stroke care and that all patients presenting with a recent transient ischaemic attack (TIA) or minor stroke are immediately referred for appropriate urgent specialist assessment and investigation[20]. GPs can play a key role in initiating and directing this rapid response. Finally, GPs can support community-based patient education and primary Myelin Basic Protein (68-82), guinea pig prevention of stroke since most stroke patients will be community dwellers (for instance, 90% of Irish stroke patients were community-dwelling before being admitted to hospital with Myelin Basic Protein (68-82), guinea pig a stroke[21]). In order for GPs to coordinate optimal stroke prevention and care, a structured approach to the detection and management of chronic disease and risk factors is needed[22,23]. Structures to facilitate this include disease registers; clinics for implementing and monitoring the effectiveness of therapy; the use of clinical guidelines or practice protocols to support clinical decisions; and clinical audit to evaluate the effectiveness of treatment provided and stimulate improvement. Information on the capacity of general practice to deliver optimal stroke care is needed. As part of a national evaluation of stroke services in Myelin Basic Protein (68-82), guinea pig Ireland[24] which assessed community, hospital and nursing home services for stroke, a survey of general practices was undertaken to determine the structures currently in place likely to support stroke prevention and care. Methods Study design, sampling and participants We conducted a postal survey among a random sample of GPs taken from a total population of 2,300 GPs in the Republic of Ireland profiled in the Irish Medical Directory 2006C2007 edition. Sampling was conducted using the random selection function in Microsoft Excel. A sample size of 242 GPs provides a 90% probability that prevalence will be within 5% of the true value. Based on an expected 50% response rate, 484 participants were selected. Selected GPs were sent an invitation letter with an explanation of the value of the survey from the study sponsor C the Irish Heart Foundation, a letter of introduction from the research team, the survey instrument, and a stamped addressed envelope. A telephone reminder followed after two weeks if GPs had not returned the questionnaire. GPs were reminded to complete and return the questionnaire, or were given the option to complete the questionnaire by telephone at a time convenient to them. A final reminder questionnaire was sent to nonresponders two weeks following the telephone approach (Figure ?(Figure1).1). Research ethics approval was granted by the Royal College of Surgeons in Ireland Research Ethics Committee (REC2006:186) Open in a separate window Number 1 Questionnaire development The survey instrument was developed by the research team based on a recent UK general practice survey (Thomas, Chappel, Thomson, & Rogers, personal correspondence, [observe Additional file 1]). The content validity and conceptual clarity of the questionnaire was.Almost all GPs (94%) managing acute stroke patients at home used aspirin, but 60% stated they aimed for acute blood pressure reduction after an acute stroke. Over 85% of GPs reported that there was no routine liaison from hospitals during admission or leading up to discharge. and might be argued to be a chronic disease with acute events[3]. Population-based data suggest that acute cerebrovascular events are at least as common as coronary events[4]. The lifetime risk of first-ever stroke from age 55 years in the Framingham cohort was as high as 1 in 5[5]. There is considerable chance for main prevention of stroke: treatments for hypertension[6,7] and non-valvular atrial fibrillation[8,9] are effective in reducing the risk of stroke, but may not be fully implemented[10]. Observational studies have shown that lifestyle factors such as diet, smoking, exercise, and alcohol intake can forecast the risk of stroke [11-13], thereby assisting the adoption of way of life risk factor changes. The actuarial risk of recurrent stroke after a first stroke is about 30% over five years[14], and there is strong evidence of the benefits of anti-platelet therapy[15], blood pressure decreasing[16] and lipid decreasing[17] in secondary prevention. Despite improvements in the use of secondary prevention medication, there is further scope for achieving more from these medications[18]. General practitioners (GPs) are well placed to implement secondary prevention programmes for stroke. For instance, in an Irish study of 195 discharged stroke patients, the majority (87%) had seen their GP since hospital discharge, whereas just less than half (48%) had been examined in hospital outpatient departments[19]. With regard to emergency care and attention, current recommendations recommend all individuals with suspected acute stroke are immediately transferred by ambulance to a receiving hospital providing acute stroke solutions and organised stroke care and that all patients showing with a recent transient ischaemic assault (TIA) or small stroke are immediately referred for appropriate urgent specialist assessment and investigation[20]. GPs can play Myelin Basic Protein (68-82), guinea pig a key part in initiating and directing this quick response. Finally, GPs can support community-based patient education and main prevention of stroke since most stroke patients will become community dwellers (for instance, 90% of Irish stroke patients were community-dwelling before becoming admitted to hospital with a stroke[21]). In order for GPs to coordinate optimal stroke prevention and care, a structured approach to the detection and management of chronic disease and risk factors is needed[22,23]. Constructions to facilitate this include disease registers; clinics for implementing and monitoring the effectiveness of therapy; the use of clinical recommendations or practice protocols to support clinical decisions; and medical audit to evaluate the effectiveness of treatment offered and stimulate improvement. Info on the capacity Rabbit Polyclonal to ZFHX3 of general practice to deliver optimal stroke care is needed. As part of a national evaluation of stroke solutions in Ireland[24] which assessed community, hospital and nursing home services for stroke, a survey of general methods was undertaken to determine the constructions currently in place likely to support stroke prevention and care. Methods Study design, sampling and participants We carried out a postal survey among a random sample of GPs taken from a total populace of 2,300 GPs in the Republic of Ireland profiled in the Irish Medical Listing 2006C2007 release. Sampling was carried out using the random selection function in Microsoft Excel. A sample size of 242 GPs provides a 90% probability that prevalence will become within 5% of the true value. Based on an expected 50% response rate, 484 participants.