Quality of secondary prevention measures in TIA patients: a retrospective cohort study
- 1Department of Health Sciences, University of Leicester, Leicester, UK
- 2Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Correspondence to Kate E Lager, Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK; kel7{at}le.ac.uk
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Contributors All authors contributed to the conception and design of the study. KL and AM and carried out data extraction and data analysis. All authors contributed to drafting and revising the manuscript.
- Received 27 September 2011
- Accepted 18 February 2012
- Published Online First 20 March 2012
Abstract
Objective Pharmacological and lifestyle interventions are recommended for the reduction of stroke risk in people who have had a transient ischaemic attack (TIA). This study aimed to investigate the quality of secondary stroke prevention in primary care following diagnosis of TIA in a specialist clinic.
Methods Quality standards were identified from the Royal College of Physicians (RCP) national clinical guideline for stroke and the general practice Quality and Outcomes Framework (QOF) indicators. Patients who were diagnosed with TIA between February and October 2009 were identified from a TIA clinic database. Achievement of quality standards was assessed 12–24 months following clinic attendance.
Results General practices were sent structured data collection forms for 233 patients, and the response rate was 80% (n=186). Complete data were available for 163 eligible patients (70%). Overall, 94% were prescribed antithrombotic medication. QOF standards were achieved by 82% for blood pressure (≤150/90 mm Hg) and 61% for total cholesterol (≤5.0 mmol/l). RCP standards were achieved by 35% for blood pressure (≤130/80 mm Hg) and 28% for total cholesterol (<4.0 mmol/l). RCP standards for the provision of dietary and exercise advice were achieved by 29% and 34% of patients, respectively.
Conclusion Only a minority of TIA patients achieved RCP standards whereas QOF standards were generally well achieved. Substantial benefits in terms of stroke prevention stand to be gained if risk factors are managed in line with more stringent RCP standards.
Footnotes
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Funding This study is supported by funds from the Department of Health Sciences and the Department of Cardiovascular Sciences, University of Leicester.
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Competing interests AM and KK have received sponsorship for attending conferences and honorariums from pharmaceutical companies that manufacture drugs for the secondary prevention of stroke.
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Ethics approval This study was carried out as part of an audit of TIA patient care. Audit approval was obtained from University Hospitals of Leicester NHS Trust, Leicester City Primary Care Trust (PCT) and Leicestershire Country and Rutland PCT. Ethics Committee approval was not required.
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Provenance and peer review Not commissioned; externally peer reviewed.
