Quality of stroke prevention in general practice: relationship with practice organization.

OBJECTIVE

To investigate the relationship between elements of practice organization related to stroke prevention in general practice, and suboptimal preventive care preceding the occurrence of stroke.

DESIGN

This study was conducted among 69 Dutch general practitioners in the Rotterdam region. Information on the implementation of elements of practice organization related to stroke prevention was collected by postal questionnaire. Data on the process of patient care were collected by means of chart review and interviews with general practitioners. Cases of stroke (n = 186) were retrospectively audited by an expert panel with guideline-based review criteria. Using logistic regression analysis we investigated the relationship between the probability of suboptimal care delivery and the presence of specific elements of practice organization related to stroke prevention (tailored information systems, formal delegation of preventive tasks, standardization of care).

RESULTS

For some elements of practice organization significant relationships with the quality of stroke prevention were found. Suboptimal care was less common among general practitioners with a higher level of noting high risk patients in the patient records (odds ratio 0.30; 95% CI 0.13-0.69, P = 0.01), delegating follow-up visits to support staff (odds ratio 0.42; 95% CI 0.22-0.82, P = 0.01) and compliance with the hypertension guideline (odds ratio 0.57; 95% CI 0.41-0.78, P = <0.001). Except for practice type (general practitioners in health centres less often provided suboptimal care, P = 0.02), no significant relationships with general practitioner and practice characteristics were found.

CONCLUSION

This study shows that general practitioners with a higher level of integrated organizational structures for stroke prevention (record keeping, formal delegation of preventive tasks, guideline compliance) are less likely to deliver suboptimal care.