Stroke follow-up in primary care: a prospective cohort study on guideline adherence.

{"article_title":"Stroke follow-up in primary care: a prospective cohort study on guideline adherence.","author":"Pedersen RA, Petursson H, Hetlevik I","journal_title":"BMC family practice","issn":"1471-2296","isbn":"","publication_date":"2018 Nov 28","volume":"19","issue":"1","first_page":"179","page_count":"","accession_number":"30486788","doi":"10.1186\/s12875-018-0872-9","publisher":"BioMed Central","doctype":"Journal Article","subjects":"Norway; Brain Ischemia prevention & control; General Practice standards; Guideline Adherence; Life Style; Secondary Prevention standards; Adult; Aged; Aged, 80 and over; Brain Ischemia epidemiology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Morbidity trends; Norway epidemiology; Prospective Studies; Risk Factors","interest_area":["Neurology"," Emergency Medicine"],"abstract":"Background: After a stroke, a person has an increased risk of recurrent strokes. Effective secondary prevention can provide significant gains in the form of reduced disability and mortality. While considerable efforts have been made to provide high quality acute treatment of stroke, there has been less focus on the follow-up in general practice after the stroke. One strategy for the implementation of high quality, evidence-based treatment is the development and distribution of clinical guidelines. However, from similar fields of practice, we know that guidelines are often not adhered to. The purpose of this study was to investigate to what degree patients who have suffered a stroke are followed up in general practice, if recommendations in the national guidelines are followed, and if patients achieve the treatment goals recommended in the guidelines. Methods: The study included patients with cerebral infarction identified by the ICD-10 discharge diagnoses I63.0 trough I63.9 in two Norwegian local hospitals. In total 51 patients participated. They were listed with general practitioners in 18 different clinics. The material consists of the general practitioners' (GPs') medical records for these patients in the first year of follow-up; in total 381 consultations. Results: Of the 381 consultations during the first year of follow-up, 71 (19%) had stroke as the main topic. The blood pressure (BP) target value < 140\/90 mmHg was reached by 24 patients (47%). The low density lipoprotein (LDL) cholesterol target value < 2.0 mmol\/L was reached by 14 (27%) of the 51 patients. In total six patients (12%) got advice on physical activity and three (6%) received dietary advice. No advice about alcohol consumption was recorded. Conclusions: The findings support earlier claims that the development and distribution of guidelines alone is not enough to implement a certain practice. Despite being a serious condition, stroke gets limited attention in the first year of follow-up in general practice. This can be explained by the complexity of general practice, where even a serious condition loses the competition for attention to other apparently equally important issues.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=30486788&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Pedersen RA, Petursson H, Hetlevik I","Journal_Info":"Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE","Publication_Type":"Journal Article; Multicenter Study; Research Support, Non-U.S. Gov&#39;t","Published_Date":"2018-11-28","Source":"BMC family practice [BMC Fam Pract] 2018 Nov 28; Vol. 19 (1), pp. 179. Date of Electronic Publication: 2018 Nov 28.","Languages":"English","Electronic_ISSN":"1471-2296","MeSH_Terms":"Guideline Adherence* , Life Style*, Brain Ischemia\/*prevention & control , General Practice\/*standards , Secondary Prevention\/*standards, Adult ; Aged ; Aged, 80 and over ; Brain Ischemia\/epidemiology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Morbidity\/trends ; Norway\/epidemiology ; Prospective Studies ; Risk Factors","Subjects":"Adult, Aged, Aged, 80 and over, Brain Ischemia epidemiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Morbidity trends, Norway epidemiology, Prospective Studies, Risk Factors, Brain Ischemia prevention & control, General Practice standards, Guideline Adherence, Life Style, Secondary Prevention standards","Title_Abbreviations":"BMC family practice","Volume":"19"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"30486788","RelevancyScore":"821","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"821.265075683594"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=30486788&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=30486788&authtype=shib&custid=ns346513&group=main&profile=eds"}