title: Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives.
abstract: To understand how service factors contribute to delays to specialist assessment following transient ischaemic attack (TIA) or minor stroke.
  
  
  
  Qualitative study using semistructured interviews, analysis by constant comparison.
  
  
  
  Leicester, UK.
  
  
  
  Patients diagnosed with TIA or minor stroke, at hospital admission or in a rapid-access TIA clinic (n=42), general practitioners (GPs) of participating patients if they had been involved in the patients' care (n=18).
  
  
  
  Accounts from patients and GPs of factors contributing to delay following action to seek help from a healthcare professional (HCP).
  
  
  
  The following categories of delay were identified. First, delay in assessment in general practice following contact with the service; this related to availability of same day appointments, and the role of the receptionist in identifying urgent cases. Second, delays in diagnosis by the HCP first consulted, including GPs, optometrists, out-of-hours services, walk-in centres and the emergency department. Third, delays in referral after a suspected diagnosis; these included variable use of the ABCD(2) (Age, Blood pressure, Clinical features, Duration, Diabetes) risk stratification score and referral templates in general practice, and referral back to the patients' GP in cases where he/she was not the first HCP consulted.
  
  
  
  Primary and emergency care providers need to review how they can best handle patients presenting with symptoms that could be due to stroke or TIA. In general practice, this may include receptionist training and/or triage by a nurse or doctor. Mechanisms need to be established to enable direct referral to the TIA clinic when patients whose symptoms have resolved present to other agencies. Further work is needed to improve diagnostic accuracy by non-specialists.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Dawn
authors.initials: D
authors.lastname: Coleby
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Regen
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Kay
authors.initials: K
authors.lastname: Phelps
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Windridge
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Willars
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Robinson
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D002985:Clinical Protocols; D057210:Delayed Diagnosis / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice; D058005:General Practitioners; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008496:Medical Receptionists / Q000193:education; D008875:Middle Aged; D036301:Qualitative Research; D012017:Referral and Consultation; D013038:Specialization; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology
keywords: ACCIDENT & EMERGENCY MEDICINE; PRIMARY CARE; STROKE MEDICINE