title: Implementation of secondary stroke prevention protocol for ischaemic stroke patients in primary care.
abstract: OBJECTIVE
  To investigate the effectiveness of a secondary stroke prevention protocol in the general out-patient clinic.
  
  
  METHODS
  Cohort study with pre- and post-intervention comparisons.
  
  
  METHODS
  Two general out-patient clinics in Hong Kong.
  
  
  METHODS
  Ischaemic stroke patients who had long-term follow-up in two clinics were recruited. The patients of one clinic received the intervention (intervention group) and the patients of the second clinic did not receive the intervention (control group). The recruitment period lasted for 6 months from 1 September 2008 to 28 February 2009. The pre-intervention phase data collection started within this 6-month period. The protocol implementation started at the intervention clinic on 1 April 2009. The post-intervention phase data collection started 9 months after the protocol implementation, and ran for 6 months from 1 January 2010 to 30 June 2010.
  
  
  METHODS
  Clinical data before and after the intervention, including blood pressure, glycated haemoglobin level, low-density lipoprotein level and prescription pattern, were compared between the two groups to see whether there was enhancement of secondary stroke management.
  
  
  RESULTS
  A total of 328 patients were recruited into the intervention group and 249 into the control group; data of 256 and 210 patients from these groups were analysed, respectively. After intervention, there were significant reductions in mean (± standard deviation) systolic blood pressure (135.2 ± 17.5 mm Hg to 127.7 ± 12.2 mm Hg), glycated haemoglobin level (7.2 ± 1.0% to 6.5 ± 0.8%), and low-density lipoprotein level (3.4 ± 0.8 mmol/L to 2.8 ± 1.3 mmol/L) in the intervention group (all P<0.01). There were no significant reductions in mean systolic blood pressure, glycated haemoglobin level, or low-density lipoprotein level in the control group. There was a significant increase in statin use (P<0.01) in both clinics.
  
  
  CONCLUSIONS
  Through implementation of a clinic protocol, the standard of care of secondary stroke prevention for ischaemic stroke patients could be improved in a general out-patient clinic.
authors.affiliation: Lek Yuen General Out-patient Clinic, Department of Family Medicine, New Territories East Cluster, Hong Kong.
authors.forename: Y K
authors.initials: YK
authors.lastname: Choi
authors.affiliation: Lek Yuen General Out-patient Clinic, Department of Family Medicine, New Territories East Cluster, Hong Kong.
authors.forename: J H
authors.initials: JH
authors.lastname: Han
authors.affiliation: Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
authors.forename: Richard
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
authors.forename: Kenny
authors.initials: K
authors.lastname: Kung
authors.affiliation: Department of Family Medicine, New Territories East Cluster, Hong Kong.
authors.forename: Augustine
authors.initials: A
authors.lastname: Lam
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D002545:Brain Ischemia / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D002985:Clinical Protocols / Q000592:standards*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006284:Health Plan Implementation; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Brain ischemia; Primary health care; Stroke/therapy