title: Cluster randomized controlled trial of TIA electronic decision support in primary care.
abstract: OBJECTIVE
  To test if TIA/stroke electronic decision support in primary care improves management.
  
  
  METHODS
  Multicenter, single-blind, parallel-group, cluster randomized, controlled trial comparing TIA/stroke electronic decision support guided management with usual care. Main outcomes were guideline adherence and 90-day stroke risk. Secondary outcomes were cerebrovascular/vascular/death/adverse events, cost, and user feedback. Main analysis was logistic regression with a normal random effect for clusters using a generalized linear mixed model.
  
  
  RESULTS
  Twenty-nine clinics were randomized to intervention, 27 to control, recruiting 172 and 119 eligible patients. More intervention patients received guideline-adherent care (131/172; 76.2%) than control patients (49/119; 41.2%) (adjusted odds ratio [OR] 4.57; 95% confidence interval [CI] 2.39-8.71; p < 0.001). Ninety-day stroke occurred in 2/172 (1.2%) intervention and 5/119 (4.2%) control patients (OR 0.27; 95% CI 0.05-1.41; p = 0.098). Ninety-day TIA or stroke occurrence was lower in the intervention group, 4/172 (2.3%) compared to 10/119 (8.5%) control (adjusted OR 0.26; 95% CI 0.70-0.97; p = 0.045). Fewer vascular events/deaths occurred in intervention, 6/172 (3.5%), than in control patients, 14/119 (11.9%) (adjusted OR 0.27; 95% CI 0.09-0.78; p = 0.016). Treatment cost ratio of 0.65 (95% CI 0.47-0.91; p = 0.013) favored the intervention without increased adverse events. Clinician feedback was positive.
  
  
  CONCLUSIONS
  Primary care use of the TIA/stroke electronic decision support tool improves guideline adherence, safely reduces treatment cost, achieves positive user feedback, and may reduce cerebrovascular and vascular event risk following TIA/stroke.
  
  
  METHODS
  This study provides Class II evidence that a primary care electronic decision support tool improves guideline adherence and might reduce 90-day stroke risk.
authors: From the Department of Neurology (A.R.), MidCentral District Health Board, Palmerston North; the Department of Medicine (A.R., M.W., D.O.), University of Otago-Wellington; the Department of General Practice and Rural Health (S.D., M.T.), University of Otago, Dunedin School of Medicine; and the Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand. anna.ranta@otago.ac.nz.
authors: Annemarei
authors: A
authors: Ranta
authors: From the Department of Neurology (A.R.), MidCentral District Health Board, Palmerston North; the Department of Medicine (A.R., M.W., D.O.), University of Otago-Wellington; the Department of General Practice and Rural Health (S.D., M.T.), University of Otago, Dunedin School of Medicine; and the Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand.
authors: Susan
authors: S
authors: Dovey
authors: From the Department of Neurology (A.R.), MidCentral District Health Board, Palmerston North; the Department of Medicine (A.R., M.W., D.O.), University of Otago-Wellington; the Department of General Practice and Rural Health (S.D., M.T.), University of Otago, Dunedin School of Medicine; and the Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand.
authors: Mark
authors: M
authors: Weatherall
authors: From the Department of Neurology (A.R.), MidCentral District Health Board, Palmerston North; the Department of Medicine (A.R., M.W., D.O.), University of Otago-Wellington; the Department of General Practice and Rural Health (S.D., M.T.), University of Otago, Dunedin School of Medicine; and the Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand.
authors: Des
authors: D
authors: O'Dea
authors: From the Department of Neurology (A.R.), MidCentral District Health Board, Palmerston North; the Department of Medicine (A.R., M.W., D.O.), University of Otago-Wellington; the Department of General Practice and Rural Health (S.D., M.T.), University of Otago, Dunedin School of Medicine; and the Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand.
authors: John
authors: J
authors: Gommans
authors: From the Department of Neurology (A.R.), MidCentral District Health Board, Palmerston North; the Department of Medicine (A.R., M.W., D.O.), University of Otago-Wellington; the Department of General Practice and Rural Health (S.D., M.T.), University of Otago, Dunedin School of Medicine; and the Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand.
authors: Murray
authors: M
authors: Tilyard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology*; D020000:Decision Support Systems, Clinical / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006401:Hematologic Agents / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000592:standards*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics / Q000592:standards; D012306:Risk; D016037:Single-Blind Method; D020521:Stroke / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D006401:Hematologic Agents