Significant improvement in TIA/Stroke Management

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.