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 .
Point-of-Care Cluster Randomized Trial in Stroke Secondary Prevention Using Electronic Health Records
Background and Purpose — The aim of this study was to evaluate whether the remote introduction of electronic decision support tools into family practice s improves risk factor control after first stroke . This study also aim ed to develop methods to implement cluster r and omized trials in stroke using electronic health records . Methods — Family practice s were recruited from the UK Clinical Practice Research Data link and allocated to intervention and control trial arms by minimization .  Remotely installed , electronic decision support tools promoted intensified secondary prevention for 12 months with last measure of systolic blood pressure as the primary outcome . Outcome data from electronic health records were analyzed using marginal models . Results — There were 106 Clinical Practice Research Data link family practice s allocated ( intervention , 53 ; control , 53 ) , with 11 391 ( control , 5516 ; intervention , 5875 ) participants with acute stroke ever diagnosed . Participants at trial practice s had similar characteristics as 47 887 patients with stroke at nontrial practice s. During the intervention period , blood pressure values were recorded in the electronic health records for 90 % and cholesterol values for 84 % of participants . After intervention , the latest mean systolic blood pressure was 131.7 ( SD , 16.8 ) mm Hg in the control trial arm and 131.4 ( 16.7 ) mm Hg in the intervention trial arm , and adjusted mean difference was −0.56 mm Hg ( 95 % confidence interval , −1.38 to 0.26 ; P=0.183 ) . The financial cost of the trial was approximately US $ 22 per participant , or US $ 2400 per family practice allocated . Conclusions — Large pragmatic intervention studies may be implemented at low cost by using electronic health records . The intervention used in this trial was not found to be effective , and further research is needed to develop more effective intervention strategies . Clinical Trial Registration — URL : http://www.controlled-trials.com . Current Controlled Trials identifier : IS RCT N35701810
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 .