on April 3, 2008
Published online before print April 3, 2008, doi: 10.1161/STROKEAHA.107.504860
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Submitted on September 18, 2007
From the Stroke Center and the Department of Neurology (B.O., J.L.S.), UCLA Medical Center, Los Angeles, Calif; the American Academy of Neurology (O.D.), St Paul, Minn; the National Institute of Neurological Disorders and Stroke (W.J.K.), Bethesda, Md; and the Department of Neurological Sciences (P.F.), University of Nebraska Medical Center, Omaha, Neb. * To whom correspondence should be addressed. E-mail: Ovibes{at}mednet.ucla.edu.
Background and Purpose—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. Methods—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. Results—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. Conclusions—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.
Revised on October 29, 2007
Accepted on November 2, 2007
Outpatient Practice Patterns After Stroke Hospitalization Among Neurologists
Bruce Ovbiagele MD*;
Key words: adherence • ischemic stroke • neurologists • practice patterns