Management of transient ischemic attacks diagnosed by early-career general practitioners: A cross-sectional study

Davey, Andrew R., Lasserson, Daniel S., Levi, Christopher R., Tapley, Amanda, Morgan, Simon, Henderson, Kim, Holliday, Elizabeth G., Ball, Jean, Van Driel, Mieke L., McArthur, Lawrie, Spike, Neil A., and Magin, Parker J. (2018) Management of transient ischemic attacks diagnosed by early-career general practitioners: A cross-sectional study. International Journal of Stroke, 13 (3). pp. 313-320.

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Background: Transient ischemic attack incurs a risk of recurrent stroke that can be dramatically reduced by urgent guideline-recommended management at the point of first medical contact. Aims: This study describes the prevalence and associations of new transient ischemic attack presentations to general practice registrars and the management undertaken. Methods: A cross-sectional analysis of the Registrar Clinical Encounters in Training cohort study. General practice registrars from five Australian states (urban to very remote practices) collected data on 60 consecutive patient encounters during each of their three six-month training terms. The proportion of problems managed being new transient ischemic attacks and proportion of transient ischemic attacks with guideline-recommended management were calculated. Univariate and multivariable logistic regression established associations of patient, registrar, and practice factors with a problem being a new transient ischemic attack. Results: A total 1331 general practice registrars contributed data (response rate 95.8%). Of the 250,625 problems, there were 65 new transient ischemic attacks diagnosed (0.03% [95% confidence interval: 0.02–0.03%]). General practice registrars were more likely to seek help, generate learning goals, and spend more time for a new transient ischemic attack compared to other problems. Compliance with management guidelines was modest: 15.4% ordered brain and arterial imaging, 36.9% prescribed antiplatelet medication, and 3.1% prescribed antihypertensive medication. Conclusions: Transient ischemic attack is a very infrequent presentation for general practice registrars, giving little clinical opportunity to reinforce training program education regarding guideline-recommended management. General practice registrars found transient ischemic attacks challenging and management was not ideal. Since most transient ischemic attacks first present to general practice and urgent management is essential, an enhanced model of care utilizing rapid access to specialist transient ischemic attack support and follow-up could improve guideline compliance.

Item ID: 75242
Item Type: Article (Research - C1)
ISSN: 1747-4949
Keywords: cerebrovascular disorders, General practice, neurology, stroke, telemedicine, transient ischemic attack, treatment
Copyright Information: © 2017 World Stroke Organization
Date Deposited: 17 Aug 2022 23:58
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420304 General practice @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3209 Neurosciences > 320905 Neurology and neuromuscular diseases @ 50%
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