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Stroke follow-up in primary care: a prospective cohort study on guideline adherence

BACKGROUND: After a stroke, a person has an increased risk of recurrent strokes. Effective secondary prevention can provide significant gains in the form of reduced disability and mortality. While considerable efforts have been made to provide high quality acute treatment of stroke, there has been l...

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Autores principales: Pedersen, Rune Aakvik, Petursson, Halfdan, Hetlevik, Irene
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263549/
https://www.ncbi.nlm.nih.gov/pubmed/30486788
http://dx.doi.org/10.1186/s12875-018-0872-9
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author Pedersen, Rune Aakvik
Petursson, Halfdan
Hetlevik, Irene
author_facet Pedersen, Rune Aakvik
Petursson, Halfdan
Hetlevik, Irene
author_sort Pedersen, Rune Aakvik
collection PubMed
description BACKGROUND: After a stroke, a person has an increased risk of recurrent strokes. Effective secondary prevention can provide significant gains in the form of reduced disability and mortality. While considerable efforts have been made to provide high quality acute treatment of stroke, there has been less focus on the follow-up in general practice after the stroke. One strategy for the implementation of high quality, evidence-based treatment is the development and distribution of clinical guidelines. However, from similar fields of practice, we know that guidelines are often not adhered to. The purpose of this study was to investigate to what degree patients who have suffered a stroke are followed up in general practice, if recommendations in the national guidelines are followed, and if patients achieve the treatment goals recommended in the guidelines. METHODS: The study included patients with cerebral infarction identified by the ICD-10 discharge diagnoses I63.0 trough I63.9 in two Norwegian local hospitals. In total 51 patients participated. They were listed with general practitioners in 18 different clinics. The material consists of the general practitioners’ (GPs’) medical records for these patients in the first year of follow-up; in total 381 consultations. RESULTS: Of the 381 consultations during the first year of follow-up, 71 (19%) had stroke as the main topic. The blood pressure (BP) target value < 140/90 mmHg was reached by 24 patients (47%). The low density lipoprotein (LDL) cholesterol target value < 2.0 mmol/L was reached by 14 (27%) of the 51 patients. In total six patients (12%) got advice on physical activity and three (6%) received dietary advice. No advice about alcohol consumption was recorded. CONCLUSIONS: The findings support earlier claims that the development and distribution of guidelines alone is not enough to implement a certain practice. Despite being a serious condition, stroke gets limited attention in the first year of follow-up in general practice. This can be explained by the complexity of general practice, where even a serious condition loses the competition for attention to other apparently equally important issues. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12875-018-0872-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-62635492018-12-05 Stroke follow-up in primary care: a prospective cohort study on guideline adherence Pedersen, Rune Aakvik Petursson, Halfdan Hetlevik, Irene BMC Fam Pract Research Article BACKGROUND: After a stroke, a person has an increased risk of recurrent strokes. Effective secondary prevention can provide significant gains in the form of reduced disability and mortality. While considerable efforts have been made to provide high quality acute treatment of stroke, there has been less focus on the follow-up in general practice after the stroke. One strategy for the implementation of high quality, evidence-based treatment is the development and distribution of clinical guidelines. However, from similar fields of practice, we know that guidelines are often not adhered to. The purpose of this study was to investigate to what degree patients who have suffered a stroke are followed up in general practice, if recommendations in the national guidelines are followed, and if patients achieve the treatment goals recommended in the guidelines. METHODS: The study included patients with cerebral infarction identified by the ICD-10 discharge diagnoses I63.0 trough I63.9 in two Norwegian local hospitals. In total 51 patients participated. They were listed with general practitioners in 18 different clinics. The material consists of the general practitioners’ (GPs’) medical records for these patients in the first year of follow-up; in total 381 consultations. RESULTS: Of the 381 consultations during the first year of follow-up, 71 (19%) had stroke as the main topic. The blood pressure (BP) target value < 140/90 mmHg was reached by 24 patients (47%). The low density lipoprotein (LDL) cholesterol target value < 2.0 mmol/L was reached by 14 (27%) of the 51 patients. In total six patients (12%) got advice on physical activity and three (6%) received dietary advice. No advice about alcohol consumption was recorded. CONCLUSIONS: The findings support earlier claims that the development and distribution of guidelines alone is not enough to implement a certain practice. Despite being a serious condition, stroke gets limited attention in the first year of follow-up in general practice. This can be explained by the complexity of general practice, where even a serious condition loses the competition for attention to other apparently equally important issues. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12875-018-0872-9) contains supplementary material, which is available to authorized users. BioMed Central 2018-11-28 /pmc/articles/PMC6263549/ /pubmed/30486788 http://dx.doi.org/10.1186/s12875-018-0872-9 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Pedersen, Rune Aakvik
Petursson, Halfdan
Hetlevik, Irene
Stroke follow-up in primary care: a prospective cohort study on guideline adherence
title Stroke follow-up in primary care: a prospective cohort study on guideline adherence
title_full Stroke follow-up in primary care: a prospective cohort study on guideline adherence
title_fullStr Stroke follow-up in primary care: a prospective cohort study on guideline adherence
title_full_unstemmed Stroke follow-up in primary care: a prospective cohort study on guideline adherence
title_short Stroke follow-up in primary care: a prospective cohort study on guideline adherence
title_sort stroke follow-up in primary care: a prospective cohort study on guideline adherence
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263549/
https://www.ncbi.nlm.nih.gov/pubmed/30486788
http://dx.doi.org/10.1186/s12875-018-0872-9
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