Lukas Geary1,2,3, Jan Hasselström4,5, Axel Carl Carlsson4, Irene Eriksson6,7, Mia von Euler1,2,7,8. 1. Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden. 2. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. 3. Unit of Medicine, Capio S:t Görans Sjukhus, Stockholm, Sweden. 4. Department of Neurobiology, Care Sciences and Society, Section of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden. 5. Academic Primary Health Care Center, Stockholm County Council, Stockholm, Sweden. 6. Department of Healthcare Development, Stockholm County Council, Stockholm, Sweden. 7. Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 8. Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.
Abstract
OBJECTIVES: The clinical benefits of use of secondary preventive pharmacotherapy in ischemic stroke/TIA have been previously demonstrated. A potential target for facilitating the use of recommended medications is primary care physicians. Therefore, we carried out an audit and feedback intervention aimed at primary care centers. The aim was to improve the use of secondary preventive stroke medications and diagnosis recording in ischemic stroke/TIA. MATERIALS AND METHODS: The intervention consisted of structured, healthcare database-derived quality reports on secondary preventive medication use and diagnosis recording, sent in 2015 to half of the primary care centers in Stockholm County, with information specific to each primary care center. Medication dispensation (primary outcome) for statins, antihypertensives, antiplatelets, and anticoagulants, as well as diagnosis recording (secondary outcome), was compared between intervention centers and control centers in the 18 months following the intervention. Outcome data were derived from the healthcare databases of Stockholm County (VAL). RESULTS:Dispensation of medications to the 12 766 patients analyzed in the study was high. Over 77% of patients used antihypertensives and antithrombotics, and 65%-68% used statins. After the intervention, no differences in medication dispensation were seen between the intervention and control centers, even after adjusting for potential confounders. CONCLUSIONS: A simple audit and feedback intervention directed toward physicians in primary care did not improve medication dispensation to ischemic stroke/TIA patients 18 months later. Any future audit and feedback intervention aimed at improving adherence to guidelines for secondary prevention in primary care should consider multiple and continuous reminders, the graphical appeal, and widening the recipients to include patients.
RCT Entities:
OBJECTIVES: The clinical benefits of use of secondary preventive pharmacotherapy in ischemic stroke/TIA have been previously demonstrated. A potential target for facilitating the use of recommended medications is primary care physicians. Therefore, we carried out an audit and feedback intervention aimed at primary care centers. The aim was to improve the use of secondary preventive stroke medications and diagnosis recording in ischemic stroke/TIA. MATERIALS AND METHODS: The intervention consisted of structured, healthcare database-derived quality reports on secondary preventive medication use and diagnosis recording, sent in 2015 to half of the primary care centers in Stockholm County, with information specific to each primary care center. Medication dispensation (primary outcome) for statins, antihypertensives, antiplatelets, and anticoagulants, as well as diagnosis recording (secondary outcome), was compared between intervention centers and control centers in the 18 months following the intervention. Outcome data were derived from the healthcare databases of Stockholm County (VAL). RESULTS: Dispensation of medications to the 12 766 patients analyzed in the study was high. Over 77% of patients used antihypertensives and antithrombotics, and 65%-68% used statins. After the intervention, no differences in medication dispensation were seen between the intervention and control centers, even after adjusting for potential confounders. CONCLUSIONS: A simple audit and feedback intervention directed toward physicians in primary care did not improve medication dispensation to ischemic stroke/TIA patients 18 months later. Any future audit and feedback intervention aimed at improving adherence to guidelines for secondary prevention in primary care should consider multiple and continuous reminders, the graphical appeal, and widening the recipients to include patients.
Authors: Hanna Sandelowsky; Björn Ställberg; Fredrik Wiklund; Gunilla Telg; Sofie de Fine Licht; Christer Janson Journal: J Asthma Allergy Date: 2022-04-13
Authors: Jaana Takala; Pinja Ilmarinen; Leena E Tuomisto; Iida Vähätalo; Onni Niemelä; Hannu Kankaanranta Journal: NPJ Prim Care Respir Med Date: 2020-03-20 Impact factor: 2.871