title: Who should manage transient ischemic attacks? A comparison between stroke experts, generalists, and electronic decision support.
abstract: OBJECTIVE
  Rapid expert management of transient ischemic attacks (TIA) has been shown to reduce the incidence of stroke, but is not always achievable. This study aims to demonstrate that TIA management by stroke experts is indeed more guideline adherent than that of generalists and that a TIA/stroke electronic decision support (EDS) tool closely mimics expert advice and improves guideline adherence.
  
  
  METHODS
  11 general practitioners (GPs), 12 general physicians, and 12 stroke specialists assessed and provided management plans for 7 hypothetical patients with potential TIAs. Responses were compared with the advice provided when patient data was entered into a TIA/stroke EDS programme.
  
  
  RESULTS
  Diagnosis and medical management was highly consistent and guideline adherent amongst stroke experts. Diagnostic accuracy was lower in the GP and general physician groups (76% and 79% respectively) and only one-third of generalists initiated best medical therapy when indicated. The TIA/stroke EDS consistently agreed with expert diagnosis, investigations, and medical management and provided most comprehensive lifestyle advice.
  
  
  CONCLUSIONS
  This study (a) confirms that stroke expert care achieves higher guideline adherence and (b) provides validation that the TIA/stroke EDS tool is able to mimic expert advice and can reliably apply best practice guidelines.
authors.affiliation: Department of Neurology, MidCentral Health, Palmerston North 4442, New Zealand. anna.ranta@otago.ac.nz
authors.forename: Annemarei
authors.initials: A
authors.lastname: Ranta
authors.forename: Pietro
authors.initials: P
authors.lastname: Cariga
mesh_terms: D003660:Decision Support Systems, Management / Q000592:standards*; D058006:General Practice / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000628:therapy*; D009462:Neurology / Q000592:standards*; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000517:prevention & control*