Diagnosis and initial management of stroke and transient ischemic attack across UK health regions from 1992 to 1996: experience of a national primary care database.
OBJECTIVE
The aim of this study was to establish the difference in burden of cerebrovascular disease across the different health regions of the United Kingdom and to determine whether the initial management of new cases of stroke and transient ischemic attack (TIA) was uniform across the United Kingdom:


METHODS
The General Practice Research Database (GPRD) is a national database used for epidemiological studies. This was a cohort study identifying incident cases of stroke and TIA over a 5-year study period between 1992 and 1996. The population studied was patients registered with general practitioners contributing to the GPRD across the different health regions of the United Kingdom: Outcome measures were new diagnoses of stroke and TIA, new prescriptions for antiplatelet and anticoagulant agents, and referrals made for specialist opinion.


RESULTS
The age-adjusted annual incidence rate across all regions was 151 per 100 000 for stroke and 190 per 100 000 for TIA. There was almost a 2-fold difference in the incidence of cerebrovascular disease between the regions. The management of stroke and TIA in terms of antiplatelet prescription and of referral onward for further opinion to hospital specialists varied significantly between regions.


CONCLUSIONS
Reported stroke and TIA incidence on the GPRD was comparable to that of other European studies. There were striking regional differences in the incidence of disease. The primary care management, both in prescription and referral rates, varied significantly between the different regions. There was a marked underuse of antiplatelet and anticoagulant agents, and referral rates for specialists' opinions were low.
Gibbs
R G
RG
Department of Vascular Surgery, Imperial College School of Medicine, Charing Cross Campus, London, UK. richard.gibbs@virgin.net
Newson
R
R
Lawrenson
R
R
Greenhalgh
R M
RM
Davies
A H
AH
D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012041:Regional Medical Programs / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006113:United Kingdom / Q000453:epidemiology
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors