Utility of electronic patient records in primary care for stroke secondary prevention trials

BMC Public Health

Research Article

Michael A Toschke¹  Martin C Gulliford²  Anthony Rudd²  Mark Ashworth²  Alex Dregan²  Charles D Wolfe² 

[1] Department of Medical Informatics, Biometry and Epidemiology (IBE) and Munich Centre of Health Sciences (MC-Health), Ludwig-Maximilians University of Munich, Munich, Germany;Division of Health and Social Care Research, King's College London, Capital House, Weston Street, London, UK;

关键词: Stroke Patient;    Stroke Prevention;    Family Practice;    Vascular Risk Factor;    Intraclass Correlation Coefficient;   

DOI  :  10.1186/1471-2458-11-86

 received in 2010-06-30, accepted in 2011-02-07,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThis study aimed to inform the design of a pragmatic trial of stroke prevention in primary care by evaluating data recorded in electronic patient records (EPRs) as potential outcome measures. The study also evaluated achievement of recommended standards of care; variation between family practices; and changes in risk factor values from before to after stroke.MethodsData from the UK General Practice Research Database (GPRD) were analysed for 22,730 participants with an index first stroke between 2003 and 2006 from 414 family practices. For each subject, the EPR was evaluated for the 12 months before and after stroke. Measures relevant to stroke secondary prevention were analysed including blood pressure (BP), cholesterol, smoking, alcohol use, body mass index (BMI), atrial fibrillation, utilisation of antihypertensive, antiplatelet and cholesterol lowering drugs. Intraclass correlation coefficients (ICC) were estimated by family practice. Random effects models were fitted to evaluate changes in risk factor values over time.ResultsIn the 12 months following stroke, BP was recorded for 90%, cholesterol for 70% and body mass index (BMI) for 47%. ICCs by family practice ranged from 0.02 for BP and BMI to 0.05 for LDL and HDL cholesterol. For subjects with records available both before and after stroke, the mean reductions from before to after stroke were: mean systolic BP, 6.02 mm Hg; diastolic BP, 2.78 mm Hg; total cholesterol, 0.60 mmol/l; BMI, 0.34 Kg/m2. There was an absolute reduction in smokers of 5% and heavy drinkers of 4%. The proportion of stroke patients within the recommended guidelines varied from less than a third (29%) for systolic BP, just over half for BMI (54%), and over 90% (92%) on alcohol consumption.ConclusionsElectronic patient records have potential for evaluation of outcomes in pragmatic trials of stroke secondary prevention. Stroke prevention interventions in primary care remain suboptimal but important reductions in vascular risk factor values were observed following stroke. Better recording of lifestyle factors in the GPRD has the potential to expand the scope of the GPRD for health care research and practice.

【 授权许可】

CC BY   
© Dregan et al; licensee BioMed Central Ltd. 2011