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

NCT ID: NCT01942031

Last Updated: 2020-09-16

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 204 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-10-31
• Study Completion Date: 2019-10-31

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.

Conditions

Ischemic Stroke; Hemorrhagic Stroke; TIA; Atrial Fibrillation

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

structured collegial feed back

Structured feed back and information about stroke to the primary care center, to physicians and head of the center

Group Type: EXPERIMENTAL

structured collegial feed back

Intervention Type: BEHAVIORAL

Collegial feed back to primary care physicians at randomized primary care centers

Control group

No structured feed back on stroke prevention. Ordinary educational activities only.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

structured collegial feed back

Collegial feed back to primary care physicians at randomized primary care centers

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Primary care center in Stockholm county

Exclusion Criteria

• localisation outside Stockholm County

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Karolinska Institutet

OTHER

Sponsor Role: lead

Responsible Party

Mia von Euler

Associate Professor, Head Karolinska Institutet Stroke Research Network at Södersjukhuset

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Mia von Euler, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Karolinska Institutet

Locations

Karolinska Institutet Stroke Research Network at Södersjukhuset

Stockholm, , Sweden

Countries

Sweden

References

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.

Reference Type: RESULT

PMID: 31017305 (View on PubMed)

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.

Reference Type: RESULT

PMID: 32327203 (View on PubMed)

Other Identifiers

EPN2010/1158-31/2

Identifier Type: -

Identifier Source: org_study_id