Increasing general practice opening hours could prevent recurrent strokes

September 19, 2008

Increasing general practice opening hours would improve the opportunity for assessment and urgent referral to specialist care of patients with a transient ischaemic attack (TIA) or minor stroke, which could prevent over 500 recurrent strokes a year in England alone, concludes a study published on bmj.com today.

Recent research shows that early assessment and treatment after a TIA and minor stroke can significantly reduce the risk of recurrent disabling or fatal stroke. The national stroke strategy and guidance from the National Institute of Health and Clinical Excellence (NICE) recommend that high risk patients must be seen within 24 hours of symptom onset.

In the UK, most patients choose to seek help from their general practice after TIA or minor stroke rather than via the emergency services.

Recent proposals to change the GP contract and increase general practices' opening hours from office hours (8am?pm Monday to Friday) to include evenings and weekends, could improve access to primary care and may influence patients' healthcare seeking behaviour and affect clinical outcomes, particularly in emergency cases such as patients with TIA and minor stroke.

Dr Daniel Lasserson and colleagues from the University of Oxford assessed the potential impact on stroke prevention of increasing primary care opening hours to 8am??pm daily. They analysed the healthcare seeking behaviour of 91,000 patients registered at nine general practices in Oxfordshire between 1 April 2002 and 31 March 2006.

The researchers recorded the time of symptom onset, time to calling healthcare services, and the choice of healthcare provider in patients with a definite or probable TIA or minor stroke.

They found that current opening hours can increase the delay in assessment. Most patients who had a TIA or minor stroke out of hours delayed seeking health care until their registered general practice was open, causing long delays in seeking treatment, particularly at weekends.

Among 359 patients with TIA and 434 with minor stroke the median time to calling a general practitioner after symptom onset was 4 hours during surgery opening hours and 24.8 hours during out of hours.

Thirteen patients who presented with a stroke had a previous TIA or minor stroke out of hours and did not seek emergency care.

The researchers report that a primary care centre open seven days a week from 8am??pm would have offered cover to 73 patients who waited until surgery opening hours to call their general practitioner, reducing median delay from 50.1 hours to 4.0 hours, and increasing those calling within 24 hours from 34% to 68%.

The authors conclude by calling for studies to examine the reasons for patients' choice of healthcare provider after TIA and minor stroke, and the reasons for the delay in seeking health care which could help inform effective public health awareness campaigns.

In an accompanying editorial, Moyez Jiwa from the Curtin Health Innovation Research Institute in Perth and Andrew Knight from the University of Sydney, say that the findings confirm that delay in access to health services has serious consequences and should be a target for improvement.

However, they suggest that public health messages alerting patients with symptoms of TIA to the need for emergency care would be of more benefit than extending general practice opening hours.

Source: British Medical Journal

Explore further: Virtual reality training may be as effective as regular therapy after stroke

Related Stories

Virtual reality training may be as effective as regular therapy after stroke

November 15, 2017
Using virtual reality therapy to improve arm and hand movement after a stroke is equally as effective as regular therapy, according to a study published in the November 15, 2017, online issue of Neurology, the medical journal ...

Landmark study may impact standard stroke treatment guidelines

November 11, 2017
Standard guidelines for stroke treatment currently recommend clot removal only within six hours of stroke onset. But a milestone study with results published today in the New England Journal of Medicine shows that clot removal ...

Groundbreaking study expands clot removal window in stroke

November 13, 2017
A procedure to remove clots from blocked brain vessels – known as thrombectomy - may be beneficial for some stroke patients even if they come in to the emergency room beyond the 6-hour treatment window that current guidelines ...

Mini-strokes can be 'ominous prelude' to catastrophic strokes

October 31, 2017
Each year, more than 200,000 Americans experience mini-strokes called transient ischemic attacks (TIAs).

Sickle cell patients suffer discrimination, poor care—and shorter lives

November 13, 2017
For more than a year, NeDina Brocks-Capla avoided one room in her large, brightly colored San Francisco house - the bathroom on the second floor.

Nitric oxide: Experimental analysis of its role in brain tissue in simulated ischemia

November 10, 2017
A joint study conducted by scientists at the National Academy of Sciences in Belarus and Kazan Federal University in Russia, looks at the role of nitric oxide (NO) in brain tissue in simulated ischemia in rats.

Recommended for you

Sunrise and sunset guide daily activities of city-dwellers

November 21, 2017
Despite artificial lightning and social conventions, the dynamics of daylight still influence the daily activities of people living in modern, urban environments, according to new research published in PLOS Computational ...

Older men need more protein to maintain muscles

November 21, 2017
The amount of protein recommended by international guidelines is not sufficient to maintain muscle size and strength in older men, according to a new study.

Exercising and eating well are greater contributors to health than standing at work

November 21, 2017
By now you've probably heard the edict from the health community: Sitting is the new smoking. Perhaps you've converted to a standing desk, or maybe you have a reminder on your phone to get up once an hour and walk around ...

Motorcycle crashes cause five times as many deaths as car accidents, six times the health costs

November 20, 2017
Motorcycle accidents are costly in terms of lives and health care costs. Compared with car accidents, motorcycle accidents cause 3 times the injuries, 6 times the medical costs and 5 times the deaths, found new research in ...

Dog ownership linked to lower mortality

November 17, 2017
A team of Swedish scientists have used national registries of more than 3.4 million Swedes aged 40 to 80 to study the association between dog ownership and cardiovascular health. Their study shows that dog owners had a lower ...

New shoe makes running 4 percent easier, 2-hour marathon possible, study shows

November 17, 2017
Eleven days after Boulder-born Shalane Flanagan won the New York City Marathon in new state-of-the-art racing flats known as "4%s," University of Colorado Boulder researchers have published the study that inspired the shoes' ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.