Stroke Secondary Prevention
There is a high risk of recurrent stroke for all patients who suffer a stroke or transient ischemic attack (TIA) in the weeks following the initial event, with most recurrent strokes occurring within 90 days. In order to investigate the prevalence, frequency,and methods to reduce the occurrence of secondary/recurrent stroke in Manchester, the Greater Manchester Connected Health City (GM CHC) Secondary Prevention Workstream was commissioned.
Firstly, to gain a greater understanding of the current landscape of stroke care and recurrence within Salford, a large cohort of data was acquired via the Salford Integrated Record (SIR) and Sentinel Stroke National Audit Programme (SSNAP). This cohort of data was to provide an insight into how well stroke patients are currently managed to blood pressure and atrial fibrillation targets within Salford. We also introduced three pilot interventions in three separate GP practices in Salford. Including enhanced communication links with the Early Supportive Discharge team, an increased role for practice-based pharmacists, and the introduction of the Performance Improvement plaN GeneratoR (PINGR) software on the practice system. A qualitative evaluation also took place alongside the introduction of pilot interventions into practices.
The cohort of SSNAP data identified 1,628 strokes between 31/12/12 to 13/11/17,and during the same time period, a subset of the SIR data identified 3,817 patients who had experienced a stroke. Due to the discrepancy in the number of records, data cleaning identified 2,995 of the patients as having either a stroke or TIA. Of these, 1,424 (47.5%) of the patients were identified as having a stroke in SSNAP within the same time period. The remaining discrepancy in the data is likely due to SSNAP not recording TIAs. Of the cohort only 38.7% had a record of their systolic blood pressure, 2.5% were recorded as having atrial fibrillation prior to stroke, and only 22% had received an ECG at some point. The pilot interventions revealed through the PINGR system that there were only 22 patients who were discharged in Salford over a 12-month period who were not under the care of the ESD team, the communication link between practice staff and the ESD team has now been established and will continue usage beyond the project, and the practice-based pharmacists were keen to scale-up their enhanced role in stroke care, despite the limited number of patients identified within the practice during the project period.
The quality and discrepancies within the SIR and SSNAP data have revealed that current recording and coding practices for stroke are not accurate enough and that improved recording will lead to better monitoring of patients post-stroke. The three pilot interventions were successful in being introduced in practice and will continue to be utilised beyond the end of the project. However, due to the limited scale of all three, further funding is unlikely to scale up any of the three interventions at this time.