There were no significant effects of organisational  interventions on lipid profile , HbA1c , medication adherence or recurrent cardiovascular events .
Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes .
The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors .
BACKGROUND People with stroke or transient ischaemic attack ( TIA ) are at increased risk of future stroke and other cardiovascular events .
Evidence -based strategies for secondary stroke prevention have been established .
However , the implementation of prevention strategies could be improved .
OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control , including patient adherence to prescribed medications , and the occurrence of secondary cardiovascular events .
Cluster randomized controlled trial of TIA electronic decision support in primary care
Objective : To test if  TIA/stroke electronic decision support in primary care improves management . Methods : Multicenter , single-blind , parallel-group , cluster r and omized , controlled trial comparing TIA/stroke electronic decision support guided management with usual care . Main outcomes were guideline adherence and 90-day stroke risk . Secondary outcomes were cerebrovascular/vascular/death/adverse events , cost , and user feedback . Main analysis was logistic regression with a normal r and om effect for clusters using a generalized linear mixed model . Results : Twenty-nine clinics were r and omized to intervention , 27 to control , recruiting 172 and 119 eligible patients . More intervention patients received guideline -adherent care ( 131/172 ; 76.2 % ) than control patients ( 49/119 ; 41.2 % ) ( adjusted odds ratio [ OR ] 4.57 ; 95 % confidence interval [ CI ] 2.39–8.71 ; p < 0.001 ) . Ninety-day stroke occurred in 2/172 ( 1.2 % ) intervention and 5/119 ( 4.2 % ) control patients ( OR 0.27 ; 95 % CI 0.05–1.41 ; p = 0.098 ) . Ninety-day TIA or stroke occurrence was lower in the intervention group , 4/172 ( 2.3 % ) compared to 10/119 ( 8.5 % ) control ( adjusted OR 0.26 ; 95 % CI 0.70–0.97 ; p = 0.045 ) . Fewer vascular events/deaths occurred in intervention , 6/172 ( 3.5 % ) , than in control patients , 14/119 ( 11.9 % ) ( adjusted OR 0.27 ; 95 % CI 0.09–0.78 ; p = 0.016 ) . Treatment cost ratio of 0.65 ( 95 % CI 0.47–0.91 ; p = 0.013 ) favored the intervention without increased adverse events . Clinician feedback was positive . Conclusion : Primary care use of the TIA/stroke electronic decision support tool  improves guideline adherence , safely reduces treatment cost , achieves positive user feedback , and may reduce cerebrovascular and vascular event risk following TIA/stroke . Classification of evidence : This study provides Class II evidence that a primary care electronic decision support tool improves guideline adherence and might reduce 90-day stroke risk
There were no significant effects of organisational  interventions on lipid profile , HbA1c , medication adherence or recurrent cardiovascular events .
Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes .
The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors .
BACKGROUND People with stroke or transient ischaemic attack ( TIA ) are at increased risk of future stroke and other cardiovascular events .
Evidence -based strategies for secondary stroke prevention have been established .
However , the implementation of prevention strategies could be improved .
OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control , including patient adherence to prescribed medications , and the occurrence of secondary cardiovascular events .