Improved Prevention of Stroke in Primary Care in Stockholm, Sweden (Förbättrad Prevention av Stroke)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01942031
Recruitment Status : Enrolling by invitation
First Posted : September 13, 2013
Last Update Posted : August 18, 2017
Information provided by (Responsible Party):
Mia von Euler, Karolinska Institutet

Brief Summary:
Stroke is a devastating disease. The acute mortality in Sweden is 20 % and 25 % of all patients relapse. Secondary prevention is proven efficient but observational studies have shown that a number of patients are lost to follow up and do not receive recommended prevention. The aim of the study is to 1) describe, by analyzing register data, the detection rate of patients with hospital diagnosis of stroke, TIA, and atrial fibrillation in the primary care center where they are listed. The analysis is done by sex, age, and socioeconomic status. Furthermore, rate of dispensed prescriptions of secondary preventive drugs are analysed for the identified population. 2) in a randomized controlled study evaluate if collegial feed back and targeted information of secondary prevention to the intervention group can improve the detection rate and the medication of the patients listed at the participating primary care centers.

Condition or disease Intervention/treatment Phase
Ischemic Stroke Hemorrhagic Stroke TIA Atrial Fibrillation Behavioral: structured collegial feed back Not Applicable

Detailed Description:

All primary care centers in Stockholm County (approximately 200) are randomised to control or intervention (receiving structured feed back on detection rate of stroke/transient ischemic attacks in comparison to hospital discharge registry data. The randomisation is done group wise based on training areas. A data set is presented by different means; 1) in written reports, directly to the head of each primary care center in the intervention group 2)in oral presentation on training sessions for the physicians in each training ares. Measures of detection rates of diagnosis and dispensed prescriptions of secondary preventive drugs are made before start of the project and after one year. The control group, ie the primary care centers not receiving feed back, are measured in the same way and thus provide a control group. The hypothesis being that with visibility of the problem, it is easier to improve care wich is what all health providers aim to do.

Outcome measures is percentage of patients with stroke (ICD code I60, I 61, I63, I64) and transitory ischemic attacks(G45) who are dispensed prescribed secondary preventive medication and death.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 204 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: An Interventional Study of How Collegial Feed Back to Primary Care Physicians on Detection of Diagnosis and Dispensation of Prescribed Secondary Preventive Drugs Affect Stroke Prevention.
Study Start Date : October 2013
Actual Primary Completion Date : December 2015
Estimated Study Completion Date : March 2018

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: structured collegial feed back
Structured feed back and information about stroke to the primary care center, to physicians and head of the center
Behavioral: structured collegial feed back
Collegial feed back to primary care physicians at randomized primary care centers

No Intervention: Control group
No structured feed back on stroke prevention. Ordinary educational activities only.

Primary Outcome Measures :
  1. percentage of identified patients with stroke/TIA in primary care and analysis of dispensed prescriptions in each group [ Time Frame: Outcome meassures will be followed during two years ]
    percentage of patients identified with hospital discharge diagnosis of stroke/TIA in primary care diagnosis register. Analysis of changes in outcome before intervention and after. the intervention will take place during one year and collection of data before start of intervention and one year after ended intervention will be performed

Secondary Outcome Measures :
  1. dispensed prescriptions of secondary preventives drugs in patients with stroke/TIA [ Time Frame: baseline 2010 and 2012, followed for one year after intervention ]
    dispensed prescriptions of recommended secondary preventive drugs in patients detected and not detected at each primary care center

Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Primary care center in Stockholm county

Exclusion Criteria:

  • localisation outside Stockholm County

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01942031

Karolinska Institutet Stroke Research Network at Södersjukhuset
Stockholm, Sweden
Sponsors and Collaborators
Karolinska Institutet
Principal Investigator: Mia von Euler, MD, PhD Karolinska Institutet

Responsible Party: Mia von Euler, Associate Professor, Head Karolinska Institutet Stroke Research Network at Södersjukhuset, Karolinska Institutet Identifier: NCT01942031     History of Changes
Other Study ID Numbers: EPN2010/1158-31/2
First Posted: September 13, 2013    Key Record Dates
Last Update Posted: August 18, 2017
Last Verified: August 2017

Keywords provided by Mia von Euler, Karolinska Institutet:
Ischemic stroke
Hemorrhagic stroke
Atrial fibrillation
primary care

Additional relevant MeSH terms:
Atrial Fibrillation
Intracranial Hemorrhages
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Arrhythmias, Cardiac
Heart Diseases
Pathologic Processes