Improved Prevention of Stroke in Primary Care in Stockholm, Sweden (Förbättrad Prevention av Stroke)

Not Applicable

Completed

• Conditions: Ischemic Stroke; Atrial Fibrillation; Hemorrhagic Stroke; TIA
• Interventions: Behavioral: structured collegial feed back

• Registration Number: NCT01942031
• Lead Sponsor: Karolinska Institutet

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.

Study Timeline

• Study First Submitted: 2013-04-15
• Study First Submitted QC: 2013-09-10
• Study First Posted: 2013-09-13
• Study Start: 2013-10
• Primary Completion: 2019-03
• Study Completion: 2019-10
• Status Verified: 2020-09
• Last Update Submitted: 2020-09-14
• Last Update Posted: 2020-09-16

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 204

Inclusion Criteria

• Primary care center in Stockholm county

Exclusion Criteria

• localisation outside Stockholm County

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
structured collegial feed back	structured collegial feed back	Structured feed back and information about stroke to the primary care center, to physicians and head of the center

Primary Outcome Measures

Name	Time	Method
percentage of identified patients with stroke/TIA in primary care and analysis of dispensed prescriptions in each group	Outcome meassures will be followed during two years	percentage of patients identified with hospital discharge diagnosis of stroke/TIA in primary care diagnosis register. Analysis of changes in outcome before intervention and after. the intervention will take place during one year and collection of data before start of intervention and one year after ended intervention will be performed

Secondary Outcome Measures

Name	Time	Method
dispensed prescriptions of secondary preventives drugs in patients with stroke/TIA	baseline 2010 and 2012, followed for one year after intervention	dispensed prescriptions of recommended secondary preventive drugs in patients detected and not detected at each primary care center

Trial Locations

Locations (1)

Karolinska Institutet Stroke Research Network at Södersjukhuset; 🇸🇪 Stockholm, Sweden