Atrial Fibrillation Clinical Trial
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.
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.
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.
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