Beech Paula, Greenhalgh Joanne, Thornton Maria, Tyrrell Pippa
Stroke Services, CSB, Hope Hospital, Stott Lane, Salford, UK.
J Eval Clin Pract. 2007 Jun;13(3):395-9. doi: 10.1111/j.1365-2753.2006.00714.x.
RATIONALE, AIMS AND OBJECTIVES: (1) To describe current practice in the establishment and running of transient ischaemic attack (TIA) clinics in the UK; (2) to identify whether TIA targets are met; (3) to inform future TIA service development.
A survey distributed to the members of the British Association of Stroke Physicians (BASP).
Forty-one per cent of full BASP members responded to the survey. TIA clinics were being run by 77% of respondents. Of the remainder 75% had plans to do so. Dedicated consultant time for stroke predominated among those involved in clinics (87% vs. 54%). The median time for clinics operation was 36 months. The median time from TIA to appointment was 2 weeks, exceeding national targets. Sixty-four per cent of clinics were run weekly and 31% more than once a week. Forty-six per cent stated they ran a one-stop clinic service yet only 10% said there were no later follow-up visits. A patient returning for completion of investigations was the most common reason for this (60%). Waits for investigations were reported - 53% indicated a wait for carotid Doppler scanning and 41% indicated this wait was in excess of 1 week.
Key areas of concern arising from this survey were that time from TIA to clinic appointment remained outside the national target and there were delays for key investigations. Current service models are inadequate to meet current TIA targets and exploration of alternative service models is required.
原理、目的和目标:(1)描述英国短暂性脑缺血发作(TIA)诊所的设立和运营现状;(2)确定是否达到TIA治疗目标;(3)为未来TIA服务的发展提供信息。
向英国中风医师协会(BASP)成员发放调查问卷。
41%的BASP正式成员回复了调查。77%的受访者表示正在运营TIA诊所。其余受访者中,75%有计划开展此项工作。参与诊所工作的人员中,专门用于中风治疗的顾问时间占主导(87%对54%)。诊所运营的中位时间为36个月。从TIA发作到预约就诊的中位时间为2周,超过了国家目标。64%的诊所每周运营,31%的诊所每周运营不止一次。46%的诊所表示提供一站式诊所服务,但只有10%表示没有后续随访。患者回来完成检查是最常见的原因(60%)。报告了检查等待时间——53%表示等待颈动脉多普勒扫描,41%表示等待时间超过1周。
本次调查引发关注的关键领域是,从TIA发作到诊所预约的时间仍未达到国家目标,且关键检查存在延迟。当前的服务模式不足以实现当前的TIA治疗目标,需要探索替代服务模式。