Clinical trial NCT01942031: Improved Prevention of Stroke in Primary Care in Stockholm, Sweden (Förbättrad Prevention av Stroke)
Official title: An Interventional Study of How Collegial Feed Back to Primary Care Physicians on Detection of Diagnosis and Dispensation of Prescribed Secondary Preventive Drugs Affect Stroke Prevention.
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Ischemic Stroke
Hemorrhagic Stroke
TIA
Atrial Fibrillation
Keywords: Ischemic stroke
Hemorrhagic stroke
TIA
Atrial fibrillation
prevention
primary care
Lead sponsor: Karolinska Institutet
Sponsor class: OTHER
First posted: 2013-09-13
Enrollment: 204
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: Stroke is a devastating disease. The acute mortality in Sweden is 20 % and 25 % of all patients relapse. Secondary prevention is proven efficient but observational studies have shown that a number of patients are lost to follow up and do not receive recommended prevention. The aim of the study is to 1) describe, by analyzing register data, the detection rate of patients with hospital diagnosis of stroke, TIA, and atrial fibrillation in the primary care center where they are listed. The analysis is done by sex, age, and socioeconomic status. Furthermore, rate of dispensed prescriptions of secondary preventive drugs are analysed for the identified population. 2) in a randomized controlled study evaluate if collegial feed back and targeted information of secondary prevention to the intervention group can improve the detection rate and the medication of the patients listed at the participating primary care centers.

Detailed description: All primary care centers in Stockholm County (approximately 200) are randomised to control or intervention (receiving structured feed back on detection rate of stroke/transient ischemic attacks in comparison to hospital discharge registry data. The randomisation is done group wise based on training areas. A data set is presented by different means; 1) in written reports, directly to the head of each primary care center in the intervention group 2)in oral presentation on training sessions for the physicians in each training ares. Measures of detection rates of diagnosis and dispensed prescriptions of secondary preventive drugs are made before start of the project and after one year. The control group, ie the primary care centers not receiving feed back, are measured in the same way and thus provide a control group. The hypothesis being that with visibility of the problem, it is easier to improve care wich is what all health providers aim to do.

Outcome measures is percentage of patients with stroke (ICD code I60, I 61, I63, I64) and transitory ischemic attacks(G45) who are dispensed prescribed secondary preventive medication and death.

Eligibility criteria: Inclusion Criteria:

* Primary care center in Stockholm county

Exclusion Criteria:

* localisation outside Stockholm County

Primary outcomes:
measure: percentage of identified patients with stroke/TIA in primary care and analysis of dispensed prescriptions in each group
timeFrame: Outcome meassures will be followed during two years
Secondary outcomes:
measure: dispensed prescriptions of secondary preventives drugs in patients with stroke/TIA
timeFrame: baseline 2010 and 2012, followed for one year after intervention
Other outcomes:
Locations:
city: Stockholm
country: Sweden
facility: Karolinska Institutet Stroke Research Network at Södersjukhuset
Study officials:
affiliation: Karolinska Institutet
name: Mia von Euler, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Geary L, Hasselstrom J, Carlsson AC, Eriksson I, von Euler M. Secondary prevention after stroke/transient ischemic attack: A randomized audit and feedback trial. Acta Neurol Scand. 2019 Aug;140(2):107-115. doi: 10.1111/ane.13109. Epub 2019 May 9.
citation: Geary L, Hasselstrom J, Carlsson AC, Schenck-Gustafsson K, von Euler M. An audit & feedback intervention for improved anticoagulant use in patients with atrial fibrillation in primary care. Int J Cardiol. 2020 Jul 1;310:67-72. doi: 10.1016/j.ijcard.2020.04.027. Epub 2020 Apr 12. No abstract available.