Transient ischaemic attacks: desired diagnosis and management by Polish primary care physicians.

OBJECTIVE: The aim of this study was to assess the competence of Polish primary care physicians in diagnosing and managing patients with transient ischaemic attacks (TIAs) in the carotid territory.
METHOD: A written questionnaire was distributed to all first-contact physicians (n = 100) in one of the seven health care districts of Warsaw (response rate 89%). The questionnaire included three pairs of TIA cases. In each of the pairs, only the age and type varied. Three cases were characterized by transient monocular blindness and the other three by symptoms of hemispheral ischaemia.
RESULTS: Physicians confronted with TIA cases had difficulties in diagnosing it. In the cases of monocular blindness, only 20-44% of cases were diagnosed correctly, and hemispheral ischaemia was diagnosed correctly in 46-78% of cases. Patients with no history of non-specific symptoms and with the first attack would have a higher percentage of correct diagnoses in comparison with those with recurrent attacks and a history of non-specific symptoms. Patients with hemispheral ischaemia frequently would be referred to neurologists, and about two-thirds of doctors would refer patients with monocular blindness to ophthalmologists, and fewer than half to neurologists. Antiplatelet therapy would be prescribed by <22% of physicians, while peripheral vasodilatators would be prescribed by up to 60% of them.
CONCLUSION: The results of this study indicate that Polish primary care physicians when confronted with TIA cases would have basic difficulties, especially in diagnosis and management. These results underline the need for changes in the vocational training of primary care physicians, with special attention to frequent family medicine problems.