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Effectiveness of a shared team approach between nurses and doctors for improved risk factor management in survivors of stroke: a cluster randomized controlled trial

Olaiya, MT, Kim, J, Nelson, MR ORCID: 0000-0001-9941-7161, Srikanth, VK, Bladin, CF, Gerraty, RP, Fitzgerald, SM, Phan, T, Frayne, J, Cadilhac, DA and Thrift, AG 2017 , 'Effectiveness of a shared team approach between nurses and doctors for improved risk factor management in survivors of stroke: a cluster randomized controlled trial' , European Journal of Neurology, vol. 24, no. 7 , pp. 920-928 , doi: 10.1111/ene.13306.

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Abstract

Background and purpose: Limited evidence exists on the benefits of organized care for improving risk factor control in patients with stroke or transient ischaemic attack. The effectiveness of an individualized management programme in reducing absolute cardiovascular disease risk in this high-risk population was determined.Methods: This was a prospective, multicentre, cluster-randomized controlled trial with blinded assessment of outcomes and intention-to-treat analysis. Patients hospitalized for stroke/transient ischaemic attack and aged ≥18 years were recruited from four hospitals. General practices treating recruited patients were randomized to provide either usual care or an individualized management programme comprising nurse-led education and review of care plans by stroke specialists in addition to usual care. The primary outcome was a change in cardiovascular Framingham Risk Score between baseline and 12 months.Results: From January 2010 to November 2013, 156 general practices (280 patients) were randomly assigned to usual care (control) and 159 (283 patients) to the intervention. The median age was 70.1 years; 65% were male. Overall, >80% of participants were prescribed recommended secondary prevention therapies at baseline. The primary efficacy analysis comprised 533 participants, with 30 either dying or lost to follow-up. In adjusted analyses, no significant between-group difference was found in the cardiovascular risk score at 12 months (0.04, 95% confidence interval -1.7, 1.8).Conclusions: The effectiveness of an organized secondary prevention programme for stroke may be limited in patients from high-performing hospitals with regular post-discharge follow-up and communication with general practices.

Item Type: Article
Authors/Creators:Olaiya, MT and Kim, J and Nelson, MR and Srikanth, VK and Bladin, CF and Gerraty, RP and Fitzgerald, SM and Phan, T and Frayne, J and Cadilhac, DA and Thrift, AG
Keywords: randomized clinical trial, risk factors, secondary prevention, stroke, transient ischaemic attack
Journal or Publication Title: European Journal of Neurology
Publisher: Blackwell Publishing Ltd
ISSN: 1351-5101
DOI / ID Number: 10.1111/ene.13306
Copyright Information:

© 2017 EAN

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