Christopher R Levi1,2,3, Daniel Lasserson4,5, Debbie Quain6, Jose Valderas7, Helen M Dewey8, P Alan Barber9, Neil Spratt1,2, Dominique A Cadilhac10,11, Valery Feigin12, Hossein Zareie6, Carlos Garcia Esperon6, Andrew Davey13, Nashwa Najib13, Parker Magin13. 1. 1 John Hunter Hospital, Hunter Medical Research Institute, Newcastle, Australia. 2. 2 Department of Neurology, The University of Newcastle, Newcastle, Australia. 3. 3 The Ingham Institute, SPHERE, Sydney, Australia. 4. 4 Institute of Applied Health Research, University of Birmingham, Birmingham, UK. 5. 5 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 6. 6 Department of Neurology, John Hunter Hospital, Newcastle, Australia. 7. 7 Health Services & Policy Research, Academic Collaboration for Primary Care (APEx), NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Exeter, UK. 8. 8 Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia. 9. 9 Department of Medicine, University of Auckland, Auckland, New Zealand. 10. 10 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Parkville, Australia. 11. 11 Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia. 12. 12 National Institute for Stroke & Applied Neurosciences, AUT University, Auckland, New Zealand. 13. 13 Discipline of General Practice, University of Newcastle, Newcastle, Australia.
Abstract
RATIONALE: Rapid response by health-care systems for transient ischemic attack and minor stroke (TIA/mS) is recommended to maximize the impact of secondary prevention strategies. The applicability of this evidence to Australian non-hospital-based TIA/mS management is uncertain. AIMS: Within an Australian community setting we seek to document processes of care, establish determinants of access to care, establish attack rates and determinants of recurrent vascular events and other clinical outcomes, establish the performance of ABC2-risk stratification, and compare the processes of care and outcomes to those in the UK and New Zealand for TIA/mS. SAMPLE SIZE ESTIMATES: Recruiting practices containing approximately 51 full-time-equivalent general practitioners to recruit 100 TIA/mS per year over a four-year study period will provide sufficient power for each of our outcomes. METHODS AND DESIGN: An inception cohort study of patients with possible TIA/mS recruited from 16 general practices in the Newcastle-Hunter Valley-Manning Valley region of Australia. Potential TIA/mS will be ascertained by multiple overlapping methods at general practices, after-hours collaborative, and hospital in-patient and outpatient services. Participants' index and subsequent clinical events will be adjudicated as TIA/mS or mimics by an expert panel. STUDY OUTCOMES: Process outcomes-whether the patient was referred for secondary care; time from event to first patient presentation to a health professional; time from event to specialist acute-access clinic appointment; time from event to brain and vascular imaging and relevant prescriptions. Clinical outcomes-recurrent stroke and major vascular events; and health-related quality of life. DISCUSSION: Community management of TIA/mS will be informed by this study.
RATIONALE: Rapid response by health-care systems for transient ischemic attack and minor stroke (TIA/mS) is recommended to maximize the impact of secondary prevention strategies. The applicability of this evidence to Australian non-hospital-based TIA/mS management is uncertain. AIMS: Within an Australian community setting we seek to document processes of care, establish determinants of access to care, establish attack rates and determinants of recurrent vascular events and other clinical outcomes, establish the performance of ABC2-risk stratification, and compare the processes of care and outcomes to those in the UK and New Zealand for TIA/mS. SAMPLE SIZE ESTIMATES: Recruiting practices containing approximately 51 full-time-equivalent general practitioners to recruit 100 TIA/mS per year over a four-year study period will provide sufficient power for each of our outcomes. METHODS AND DESIGN: An inception cohort study of patients with possible TIA/mS recruited from 16 general practices in the Newcastle-Hunter Valley-Manning Valley region of Australia. Potential TIA/mS will be ascertained by multiple overlapping methods at general practices, after-hours collaborative, and hospital in-patient and outpatient services. Participants' index and subsequent clinical events will be adjudicated as TIA/mS or mimics by an expert panel. STUDY OUTCOMES: Process outcomes-whether the patient was referred for secondary care; time from event to first patient presentation to a health professional; time from event to specialist acute-access clinic appointment; time from event to brain and vascular imaging and relevant prescriptions. Clinical outcomes-recurrent stroke and major vascular events; and health-related quality of life. DISCUSSION: Community management of TIA/mS will be informed by this study.
Entities:
Keywords:
Family practice; access; and evaluation; delivery of health care; general practice; health behavior; health care quality; transient ischemic attack
Authors: Shinya Tomari; Christopher R Levi; Elizabeth Holliday; Daniel Lasserson; Jose M Valderas; Helen M Dewey; P Alan Barber; Neil J Spratt; Dominique A Cadilhac; Valery L Feigin; Peter M Rothwell; Hossein Zareie; Carlos Garcia-Esperon; Andrew Davey; Nashwa Najib; Milton Sales; Parker Magin Journal: Front Neurol Date: 2021-12-20 Impact factor: 4.003