Department of General Practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
BMC Fam Pract. 2013 Jun 4;14:74. doi: 10.1186/1471-2296-14-74.
Earlier research showed that healthcare in stroke could be better organized, aiming for improved survival and less comorbidity. Therefore, in 2004 the Dutch College of General Practitioners (NHG) and the Dutch Association of Neurology (NVN) introduced the 'Dutch Transmural Protocol TIA/CVA' (the LTA) to improve survival, minimize the risk of stroke recurrence, and increase quality of life after stroke. This study examines whether survival improved after implementation of the new protocol, and whether there was an increase in contacts with the general practitioner (GP)/nurse practitioner, registration of comorbidity and prescription of medication.
From the primary care database of the Registration Network Groningen (RNG) two cohorts were composed: one cohort compiled before and one after introduction of the LTA. Cohort 1 (n = 131, first stroke 2001-2002) was compared with cohort 2 (n = 132, first stroke 2005-2006) with regard to survival and the secondary outcomes.
Comparison of the two cohorts showed no significant improvement in survival. In cohort 2, the number of contacts with the GP was significantly lower and with the nurse practitioner significantly higher, compared with cohort 1. All risk factors for stroke were more prevalent in cohort 2, but were only significant for hypercholesterolemia. In both cohorts more medication was prescribed after stroke, whereas ACE inhibitors were prescribed more frequently only in cohort 2.
No major changes in survival and secondary outcomes were apparent after introduction of the LTA. Although, there was a small improvement in secondary prevention, this study shows that optimal treatment after introduction of the LTA has not yet been achieved.
早期的研究表明，脑卒中的医疗保健可以更好地组织，旨在提高生存率和减少合并症。因此，2004 年荷兰全科医生学院（NHG）和荷兰神经病学协会（NVN）引入了“荷兰透壁性短暂性脑缺血发作/脑梗死协议（LTA）”，以提高生存率，降低中风复发风险，并提高中风后的生活质量。本研究旨在考察新协议实施后生存率是否有所提高，以及与全科医生/执业护士的接触、合并症的登记和药物处方是否有所增加。
从格罗宁根注册网络（RNG）的初级保健数据库中，组成了两个队列：一个队列在引入 LTA 之前（队列 1，n=131，首次中风 2001-2002 年），另一个队列在引入 LTA 之后（队列 2，n=132，首次中风 2005-2006 年）。比较了两个队列的生存率和次要结局。
与队列 1 相比，队列 2 的生存率没有显著提高。与队列 1 相比，队列 2 与全科医生的接触次数明显减少，与护士执业者的接触次数明显增加。在队列 2 中，所有的中风风险因素都更为普遍，但仅胆固醇升高具有统计学意义。两个队列中风后开的药都有所增加，而仅在队列 2 中开了更多的 ACE 抑制剂。
引入 LTA 后，生存率和次要结局没有明显变化。虽然二级预防略有改善，但本研究表明，引入 LTA 后，还没有达到最佳的治疗效果。
