title: Secondary prevention of stroke: an evidence-based clinical audit in the primary care.
abstract: OBJECTIVE
  To audit secondary preventive care in non-acute stroke patients in a local General Outpatient Clinic of the Hospital Authority.
  
  
  METHODS
  Comparison of two samples from a case series at different time-points.
  
  
  METHODS
  General Outpatient Clinic, Hong Kong.
  
  
  METHODS
  Non-acute stroke patients fulfilling the inclusion criteria and regularly followed up in a local General Outpatient Clinic during the audit cycle were recruited. Evidence-based audit criteria and performance standards were established after thorough literature review. A sample from this case series was compared retrospectively at two time-points. First-phase evaluation was performed in October 2009 and deficiencies were identified. After 9 months of active intervention, second-phase evaluation was performed in July 2010. Chi squared test and student's t test were used to compare the significance of relevant changes noted.
  
  
  RESULTS
  First-phase data showed marked deficiencies in proper assessment of cardiovascular risk factors. Satisfactory blood pressure, glucose and lipid control was evident only in 47% of the hypertensive, 45% of the diabetic, and 37% of the dyslipidaemic stroke patients, respectively. After 9 months of implementing changes, significant improvements were noted with respect to standard targets being achieved. In the second phase, more comprehensive tackling of cardiovascular risk factors was noted, with satisfactory blood pressure control in 73% of hypertensive patients, and adequate metabolic control in 62% diabetic patients (P<0.01 for both). Only 59% of the dyslipidaemic stroke patients had optimal lipid control, though their mean low-density lipoprotein concentration was significantly reduced (P<0.05).
  
  
  CONCLUSIONS
  This study provided a valuable lesson in identifying deficiencies in secondary prevention for stroke patients managed in a local primary care facility. Using a team approach intervention, quality assurance was promoted and a definite impact on patient care was demonstrated.
authors.affiliation: Department of Family Medicine & GOPC, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong. cxrchenw@hotmail.com
authors.forename: Catherine X R
authors.initials: CX
authors.lastname: Chen
authors.forename: S L
authors.initials: SL
authors.lastname: Chan
authors.forename: T C
authors.initials: TC
authors.lastname: Law
authors.forename: S K
authors.initials: SK
authors.lastname: Choi
authors.forename: K H
authors.initials: KH
authors.lastname: Chan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood; D054869:Clinical Audit; D048909:Diabetes Complications / Q000150:complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000517:prevention & control; D050171:Dyslipidemias / Q000150:complications / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005260:Female; D006442:Glycated Hemoglobin; D006723:Hong Kong; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000097:blood / Q000209:etiology / Q000517:prevention & control*
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin