Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Stroke Management in Australian General Practices: a Data Linkage Study (#41)

Muideen Olaiya 1 , Joosup Kim 1 2 , Chris Pearce 3 , Kiran Bam 1 , Dominique Cadilhac 1 2 , Nadine Andrew 4 5 , Lauren Sanders 6 7 , Amanda Thrift 1 , Mark Nelson 8 , Seana Gall 8 , Monique Kilkenny 1 2
  1. Monash University, Clayton, VICTORIA, Australia
  2. Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
  3. Outcome Health, Blackburn, Victoria, Australia
  4. Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
  5. National Centre for Healthy Ageing, Frankston, Victoria, Australia
  6. St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
  7. Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
  8. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

Background: Little is known about the management of stroke in Australian general practices.

Aims: To evaluate the quality of care and outcomes of patients with stroke/TIA in Australian general practices.

Methods: A retrospective analysis of adults with acute stroke/TIA (2014-2018) using Australian Stroke Clinical Registry data linked with de-identified general practice data (2013-2020) from three Victorian Primary Health Networks (Eastern Melbourne, Gippsland, South Eastern Melbourne). Eligibility included being discharged home or to rehabilitation, and having ≥2 general practice encounters within 7-18 months post-stroke/TIA. General practice management within 7-18 months post-stroke/TIA was evaluated based on: assessment of five cardiometabolic risk factors (blood pressure [BP], serum lipids, blood glucose, serum proteins, body weight); and prescription of prevention medication (BP-, lipid-, glucose-lowering, and antithrombotic agents). Outcomes included attainment of guideline-recommended targets for the cardiometabolic risk factors. Quality of care and patient outcomes were summarised using descriptive statistics, and associated factors determined using stepwise multivariable regression.

Results: A total of 3,528 people were eligible (median age 74 years, 44% females, 22% TIA, 383 general practices). Within 7-18 months post-stroke/TIA, there was a median 10 encounters with general practice, 3,027 patients (86%) with records of risk factors (median three risk factors assessed), and 1,380 (39%) prescribed all of BP-lowering, lipid-lowering, and antithrombotic medications. BP was the most commonly assessed risk factor (79%). Factors most strongly associated with having fewer risk factors assessed, or fewer medication classes prescribed, included younger or older age (reference 61-80 years) and being female. Risk factor targets were most commonly achieved for blood glucose (78%), and least commonly for serum proteins (27%).

Conclusions: We identified gaps that could inform quality improvement efforts for managing stroke/TIA in Australian general practices. Findings may be limited by the quality of data captured in practices, and completeness of health information transferred (e.g. pathology) to practices.