A University of Otago study published in the latest edition of the journal Neurology shows that use of the BPAC Inc. TIA/Stroke electronic decision support tool improves GP adherence to guidelines and reduces treatment cost, while possibly reducing the risk of further TIA and stroke.
The TIA/Stroke tool provides decision support for general practitioners in the assessment, diagnostic testing, management and referral of TIA and stroke patients. The tool came about as a collaboration between Dr Anna Ranta, a consultant Neurologist from Mid-Central DHB, who provided clinical leadership for the project, and a development team from BPAC Inc. led by Jason Hall. It was launched in 32 primary care practices throughout the Mid-Central DHB area in late 2009 after a successful pilot study, and updated in time for the University of Otago’s FASTEST (Efficacy and Safety of a TIA/Stroke Electronic Support Tool) study, which took place from February 2012 until May 2013.
The FASTEST study randomised 56 general practice clinics to a control group of 27 and an intervention group of 29 clinics who were to use the decision support tool. The practices recruited 119 (control) and 172 (intervention) eligible patients who attended a participating clinic as their first point of care after experiencing symptoms of what was diagnosed by their GP as a stroke or TIA.
The study found that use of the TIA/Stroke tool was associated with an increased rate of care that adhered to established clinical guidelines. Without the decision support tool, only 41.2% of patients received care that followed Stroke Foundation Guidelines. In contrast 76.2% of patients received guideline-adherent care when the TIA/Stroke Decision Support tool was used. Treatment cost was lower in the intervention group, with a cost ratio of 0.65, without compromising safety. Practitioner feedback regarding the tool has been overwhelmingly positive.
In terms of clinical outcome, the prevalence of stroke or TIA within 90 days in the intervention group was 2.3%, significantly different from that of the control group at 8.5%. The prevalence of stroke alone was not significantly different between groups, but the level of vascular events and deaths was lower in the intervention group than in the control, at 3.5% and 11% respectively. The outcomes of the FASTEST study have been an important factor in the granting of Ministry of Health funding enabling the TIA/Stroke tool to be rolled out nationwide, a process begun in March 2015. Further data will be collected on the outcomes of the use of the tool across New Zealand and will hopefully provide further evidence of its effectiveness in improving clinical practice in regards to TIA/Stroke management.
The INR Monitoring module utilises a formula developed by Ryan et al which assists clinicians adjust oral anticoagulant doses in patients. It also recommends the time interval for the next follow up visit and prints a Patient Dose calendar if required.
For more modules see the full list of standard modules.
In response to feedback, the online ACC18 continues to launch enhancements; the following will be available from 27 November.
Fitness for Work Tab - Calendar: Moving the mouse over the calendar for longer periods has been made easier.
Declaration Tab - ACC Identification: There will be a reduction in the number of identifiers from five to four; no direct impact on the Provider.
If you are one of the over 2000 Practitioners who regularly use the online ACC18; thank you. If you are not then now would be a good time to begin, noting that additional return to work assistance for patients is offered solely through this online form. Self service for setting up and using the online ACC18 is available at www.acc.co.nz (use keyword eACC18 Self Service). However, feel free to contact ACC at 0800 222 994 or ebusinessinfo@acc.co.nz for more personalised support.
The five most popular modules in June were:
To see more, go to the Statistics page.
The Getting Started guide is a good place to start if you are new to bestpractice Decision Support. The articles in the guide provide a quick and focussed introduction to the areas of most interest to new users of bestpractice.
bestpractice Decision Support is produced by BPAC Inc. To find out more about us, click here.