Ovbiagele Bruce, Drogan Oksana, Koroshetz Walter J, Fayad Pierre, Saver Jeffrey L
Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA.
Stroke. 2008 Jun;39(6):1850-4. doi: 10.1161/STROKEAHA.107.504860. Epub 2008 Apr 3.
Care after stroke hospitalization can provide several opportunities to optimize vascular risk reduction. However, not much is known about poststroke practice patterns among neurologists. Such knowledge may help direct specific efforts to improve the impact of practicing neurologists on clinical outcomes after stroke.
A survey soliciting information on processes of care in the outpatient setting after recent hospitalization for ischemic stroke or transient ischemic attack was mailed to a random sample of 833 US and Canadian neurologist-members of the American Academy of Neurology.
A total of 475 (57%) responses were received. Practice demographics of survey responders and nonresponders were largely similar. Fourteen percent of respondents identified themselves as vascular neurologists. Overall, respondents reported frequently checking for medication adherence and counseling patients on lifestyle modification. However, neurologists reported screening more frequently for diabetes, hypertension, and dyslipidemia than actually treating these conditions (all P<0.0001) Vascular neurologists were more likely than general neurologists to screen for hypertension (97% versus 86%, P=0.016), dyslipidemia (94% versus 68%, P<0.001), diabetes (89% versus 62%, P<0.001), and sleep apnea (94% versus 79%, P=0.007) as well as to treat hypertension (71% versus 45%, P<0.001), dyslipidemia (82% versus 50%, P<0.001), diabetes (45% versus 21%, P<0.001), and current smoking (77% versus 59%, P=0.005). Neurologists with mostly government-insured and uninsured patients were significantly more likely to engage in vascular risk reduction treatment than neurologists with mostly commercially insured patients.
Self-reported rates of screening and treatment of major vascular risk factors by most neurologists after stroke hospitalization are substantial but not universal. Bridging knowledge gaps or adopting a systematic management approach in coordination with primary care physicians could help optimize poststroke care.
中风住院后的护理可提供多个优化降低血管风险的机会。然而，对于神经科医生的中风后实践模式了解甚少。此类知识可能有助于指导具体工作，以提高执业神经科医生对中风后临床结局的影响。
向美国神经病学学会的833名美国和加拿大神经科医生会员随机抽样邮寄了一份调查问卷，征求有关缺血性中风或短暂性脑缺血发作近期住院后门诊护理过程的信息。
共收到475份（57%）回复。回复者和未回复者的执业人口统计学特征基本相似。14%的受访者称自己为血管神经科医生。总体而言，受访者报告经常检查药物依从性并就生活方式改变向患者提供咨询。然而，神经科医生报告对糖尿病、高血压和血脂异常的筛查频率高于实际治疗这些疾病的频率（所有P<0.0001）。血管神经科医生比普通神经科医生更有可能筛查高血压（97%对86%，P=0.016）、血脂异常（94%对68%，P<0.001）、糖尿病（89%对62%，P<0.001）和睡眠呼吸暂停（94%对79%，P=0.007），也更有可能治疗高血压（71%对45%，P<0.001）、血脂异常（82%对50%，P<0.001）、糖尿病（45%对21%，P<0.001）和当前吸烟（77%对59%，P=0.005）。主要诊治政府保险和未参保患者的神经科医生比主要诊治商业保险患者的神经科医生更有可能进行血管风险降低治疗。
大多数神经科医生在中风住院后自我报告的主要血管危险因素筛查和治疗率较高，但并不普遍。弥合知识差距或与初级保健医生协调采用系统管理方法有助于优化中风后护理。
