Outpatient Management of Transient Ischaemic Attacks by the General Practitioner in an Australian Outer Metropolitan Region
Objective: This study was to identify differences in implementation of established secondary stroke prevention strategies by the GPs in the region.
Design: A survey among 280 GPs around the main academic Hospital in Frankston. GP attitudes and practises were assessed with a postal questionnaire.
Main outcome measures: Factors influencing the decision of GPs to refer patients to hospital, time taken for relevant investigations and deviations from the established guidelines for the region.
Results: 60 GPs (21%) responded. Most (55) were informative. The main interventions GPs performed were prescription of Aspirin (50%), Aspirin with Dipyridamole (39%), Cholesterol lowering medication (87%) and an ACEI (90%). Most (92%) used warfarin for patients with atrial fibrillation, clopidogrel (53%) to replace dipyridamole when combined with aspirin and warfarin (45%) to replace the combination of aspirin and clopidogrel. Only 19% referred all TIA patients immediately to an emergency department. CT Brain and carotid Doppler (38%) and persistent symptoms (35%) were the main reasons for hospital referral. Most were not able to get an immediate neurology consult. The majority were able to get a CT Brain (93%), ECG (98%), Carotid Doppler (70%), basic bloods (98%) performed within two days of the TIA.
Conclusion: There is a low response bias in this study. Nevertheless, the data available shows that GPs are less likely to deliver suboptimal care unless they are confronted with complex regimens. Significant trends to self manage, TIA patients in their own practice were noted, when symptoms are fully recovered and early investigations are feasible.