Management of people after stroke in 383 Victorian general practices, 2014–2018: analysis of linked stroke registry and general practice data

IF 6.7 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medical Journal of Australia Pub Date : 2024-11-17 DOI:10.5694/mja2.52511

Muideen T Olaiya, Joosup Kim, Christopher Pearce, Kiran Bam, Dominique A Cadilhac, Nadine E Andrew, Lauren M Sanders, Amanda G Thrift, Mark R Nelson, Seana Gall, Monique F Kilkenny

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引用次数: 0

Abstract

Objective

To evaluate the management in Victorian general practice of people who have been hospitalised with stroke or transient ischaemic attacks (TIA).

Study design

Retrospective observational study; analysis of linked Australian Stroke Clinical Registry (AuSCR) and general practice data.

Setting

383 general practices in the Eastern Melbourne, South Eastern Melbourne, and Gippsland primary health networks (Victoria), 1 January 2014 – 31 December 2018.

Participants

Adults who had been hospitalised with acute stroke or TIA and had at least two encounters with the same general practice during the observation period (7–18 months after the acute event).

Main outcome measures

Assessment of cardiometabolic risk factors (blood pressure, serum lipids, blood glucose, urinary protein); prescribing of guideline-recommended prevention medications (blood pressure-, lipid-, or glucose-lowering, antithrombotic agents); attainment of guideline targets for cardiometabolic risk factors at final assessment during observation period.

Results

During 2014–2018, 3376 eligible AuSCR registrants (1465 women, 43.4%) had at least two encounters with one of the 383 general practices during the observation period; median age at stroke onset was 73.9 (interquartile range, 64.4–81.9) years, 737 events were TIAs (21.8%). Blood pressure was assessed in 2718 patients (80.5%), serum lipids in 1830 (54.2%), blood glucose in 1708 (50.6%). Prevention medications were prescribed for 2949 patients (87.4%), including lipid-lowering (2427, 71.9%) and blood pressure-lowering agents (2363, 70.0%). Blood glucose targets had been achieved by 1346 of 1708 patients assessed for this risk factor (78.8%), blood pressure targets by 1935 of 2717 (71.2%), and serum lipid targets by 765 of 1830 (41.8%). The incidence of having risk factors assessed was lower among patients aged 60 years or younger (incidence rate ratio [IRR], 0.97; 95% confidence interval [CI], 0.92–1.03) and those over 80 years of age (IRR, 0.92; 95% CI 0.88–0.97) than for those aged 61–80 years, and for women (IRR, 0.91; 95% CI, 0.87–0.95) and people with dementia (IRR, 0.89; 95% CI, 0.81–0.98). The likelihood of having classes of prevention medication prescribed was lower for patients aged 60 years or younger (IRR, 0.92; 95% CI, 0.88–0.97) and those over 80 years of age (IRR, 0.96; 95% CI, 0.92–0.997) than for patients aged 61–80 years, and for women (IRR, 0.95; 95% CI, 0.91–0.98) and people with dementia (IRR, 0.88; 95% CI, 0.78–0.98).

Conclusions

The general practice management of people who have been hospitalised with stroke or TIA could be improved. Effective monitoring of cardiometabolic risk factors will enable general practitioners to optimise care for people who need careful attention to prevent adverse secondary events.

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2014-2018 年维多利亚州 383 家全科诊所对中风患者的管理：中风登记和全科诊所关联数据分析。

目的：评估维多利亚州全科医生对中风或短暂性脑缺血发作（TIA）住院患者的管理：评估维多利亚州全科医生对中风或短暂性脑缺血发作（TIA）住院患者的管理情况：研究设计：回顾性观察研究；分析关联的澳大利亚中风临床登记处（AuSCR）和全科医生数据：2014年1月1日至2018年12月31日，墨尔本东部、墨尔本东南部和吉普斯兰初级医疗网络（维多利亚州）的383家全科诊所：曾因急性中风或 TIA 住院治疗，且在观察期间（急性事件发生后 7-18 个月）至少在同一全科诊所就诊两次的成年人：评估心脏代谢风险因素（血压、血脂、血糖、尿蛋白）；开具指南推荐的预防药物（降压药、降脂药或降糖药、抗血栓药）；在观察期内的最终评估中达到心脏代谢风险因素的指南目标：2014-2018年期间，3376名符合条件的AuSCR注册者（1465名女性，43.4%）在观察期内与383家全科诊所中的一家至少有过两次会面；中风发病时的中位年龄为73.9（四分位间范围为64.4-81.9）岁，737起事件为TIA（21.8%）。2718 名患者（80.5%）接受了血压评估，1830 名患者（54.2%）接受了血脂评估，1708 名患者（50.6%）接受了血糖评估。为 2949 名患者（87.4%）开具了预防药物处方，包括降脂药（2427 人，71.9%）和降压药（2363 人，70.0%）。在因这一风险因素而接受评估的 1708 名患者中，有 1346 人（78.8%）达到了血糖目标；在 2717 名患者中，有 1935 人（71.2%）达到了血压目标；在 1830 名患者中，有 765 人（41.8%）达到了血脂目标。60 岁或以下患者（发病率比 [IRR]，0.97；95% 置信区间 [CI]，0.92-1.03）和 80 岁以上患者（发病率比 [IRR]，0.92；95% 置信区间 [CI]，0.88-0.97）接受风险因素评估的几率低于 61-80 岁患者，也低于女性（发病率比 [IRR]，0.91；95% 置信区间 [CI]，0.87-0.95）和痴呆患者（发病率比 [IRR]，0.89；95% 置信区间 [CI]，0.81-0.98）。与 61-80 岁的患者相比，60 岁及以下（IRR，0.92；95% CI，0.88-0.97）和 80 岁以上（IRR，0.96；95% CI，0.92-0.997）的患者以及女性（IRR，0.95；95% CI，0.91-0.98）和痴呆症患者（IRR，0.88；95% CI，0.78-0.98）接受预防药物治疗的可能性较低：全科医生对中风或 TIA 住院患者的管理有待改进。结论：全科医生对中风或 TIA 住院患者的管理有待改进。有效监测心脏代谢风险因素将使全科医生能够优化对需要仔细关注的患者的护理，以防止不良继发事件的发生。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical Journal of Australia 医学-医学：内科

CiteScore

9.40

自引率

5.30%

发文量

410

审稿时长

3-8 weeks

期刊介绍： The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.