Rural versus metropolitan comparison of processes of care in the community‐based management of TIA and minor stroke in Australia (an analysis from the INSIST study)

Gangadharan, S; Tomari, S; Levi, CR; Weaver, N; Holliday, E; Bajorek, B; Lasserson, D; Valderas, JM; Dewey, HM; Barber, PA; Spratt, NJ; Cadilhac, DA; Feigin, VL; Rothwell, PM; Zareie, H; Garcia‐Esperon, C; Davey, A

Rural versus metropolitan comparison of processes of care in the community‐based management of TIA and minor stroke in Australia (an analysis from the INSIST study)

Gangadharan, S Tomari, S Levi, CR Weaver, N Holliday, E Bajorek, B

Lasserson, D Valderas, JM Dewey, HM Barber, PA Spratt, NJ Cadilhac, DA Feigin, VL Rothwell, PM Zareie, H Garcia‐Esperon, C Davey, A

Permalink

Publisher:: Wiley
Publication Type:: Journal Article
Citation:: Australian Journal of Rural Health, 2023, 31, (2), pp. 274-284
Issue Date:: 2023-11-16

Open Access

Copyright Clearance Process

Recently Added
In Progress
Open Access

This item is open access.

Adobe PDF

Download Published versionAdobe PDF (943.92 kB)

View on publisher's site

View statistics

Full metadata record

Field	Value	Language
dc.contributor.author	Gangadharan, S
dc.contributor.author	Tomari, S
dc.contributor.author	Levi, CR
dc.contributor.author	Weaver, N
dc.contributor.author	Holliday, E
dc.contributor.author	Bajorek, B https://orcid.org/0000-0002-2532-7187
dc.contributor.author	Lasserson, D
dc.contributor.author	Valderas, JM
dc.contributor.author	Dewey, HM
dc.contributor.author	Barber, PA
dc.contributor.author	Spratt, NJ
dc.contributor.author	Cadilhac, DA
dc.contributor.author	Feigin, VL
dc.contributor.author	Rothwell, PM
dc.contributor.author	Zareie, H
dc.contributor.author	Garcia‐Esperon, C
dc.contributor.author	Davey, A
dc.date.accessioned	2023-10-18T01:12:45Z
dc.date.available	2022-11-01
dc.date.available	2023-10-18T01:12:45Z
dc.date.issued	2023-11-16
dc.identifier.citation	Australian Journal of Rural Health, 2023, 31, (2), pp. 274-284
dc.identifier.issn	1038-5282
dc.identifier.issn	1440-1584
dc.identifier.uri	http://hdl.handle.net/10453/172772
dc.description.abstract	OBJECTIVES: To compare processes of care and clinical outcomes of community-based management of TIAs and minor strokes (TIAMS) between rural and metropolitan Australia.DESIGN: Inception cohort study between 2012 and 2016 with 12-month follow-up after index event (sub-study of INSIST).SETTING: Hunter and Manning valley regions of New South Wales, within the referral territory of the John Hunter Hospital Acute Neurovascular Clinic (JHHANC).PARTICIPANTS: Consecutive patients of 16 participating general practices, presenting with possible TIAMS to either primary or secondary care.MAIN OUTCOME MEASURES: Processes of care (referrals, key management processes, time-based metrics) and clinical outcomes.RESULTS: Of 613 participants with possible TIAMS who completed the baseline interview, 298 were adjudicated as having TIAMS (119 from rural, 179 from metropolitan). Mean age was 72.3 years (SD, 10.7) and 127 (43%) were women. Rural participants were more likely to be managed solely by a general practitioner (GP) than metropolitan participants (34% v 20%) and less likely to be referred to a JHHANC specialist (13% v 38%) or have brain magnetic resonance imaging (MRI) [24% v 51%]. Those rural participants who were referred, also waited longer (both p 0.001). Recurrent stroke, myocardial infarction and death at 12 months were not significantly different between rural and metropolitan participants.CONCLUSIONS: Although TIAMS prognosis in rural settings where solely GP care is common is very good, the processes of care in such areas are inferior to metropolitan. This suggests there is further scope to support rural GPs to optimise care of TIAMS patients.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	Australian Journal of Rural Health
dc.relation.isbasedon	10.1111/ajr.12950
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	11 Medical and Health Sciences, 16 Studies in Human Society
dc.subject.classification	32 Biomedical and clinical sciences
dc.subject.classification	42 Health sciences
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Australia
dc.subject.mesh	Cohort Studies
dc.subject.mesh	General Practice
dc.subject.mesh	Ischemic Attack, Transient
dc.subject.mesh	Stroke
dc.subject.mesh	Patient Reported Outcome Measures
dc.subject.mesh	Delivery of Health Care
dc.subject.mesh	Community Health Services
dc.subject.mesh	Rural Health Services
dc.subject.mesh	Humans
dc.subject.mesh	Ischemic Attack, Transient
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Aged
dc.subject.mesh	Community Health Services
dc.subject.mesh	Rural Health Services
dc.subject.mesh	Delivery of Health Care
dc.subject.mesh	Australia
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Stroke
dc.subject.mesh	General Practice
dc.subject.mesh	Patient Reported Outcome Measures
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Australia
dc.subject.mesh	Cohort Studies
dc.subject.mesh	General Practice
dc.subject.mesh	Ischemic Attack, Transient
dc.subject.mesh	Stroke
dc.subject.mesh	Patient Reported Outcome Measures
dc.subject.mesh	Delivery of Health Care
dc.subject.mesh	Community Health Services
dc.subject.mesh	Rural Health Services
dc.title	Rural versus metropolitan comparison of processes of care in the community‐based management of TIA and minor stroke in Australia (an analysis from the INSIST study)
dc.type	Journal Article
utslib.citation.volume	31
utslib.location.activity	Australia
utslib.for	11 Medical and Health Sciences
utslib.for	16 Studies in Human Society
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health/GSH.Pharmacy
utslib.copyright.status	open_access	*
pubs.consider-herdc	true
dc.date.updated	2023-10-18T01:12:44Z
pubs.issue	2
pubs.publication-status	Accepted
pubs.volume	31
utslib.citation.issue	2

Abstract:

OBJECTIVES: To compare processes of care and clinical outcomes of community-based management of TIAs and minor strokes (TIAMS) between rural and metropolitan Australia.DESIGN: Inception cohort study between 2012 and 2016 with 12-month follow-up after index event (sub-study of INSIST).SETTING: Hunter and Manning valley regions of New South Wales, within the referral territory of the John Hunter Hospital Acute Neurovascular Clinic (JHHANC).PARTICIPANTS: Consecutive patients of 16 participating general practices, presenting with possible TIAMS to either primary or secondary care.MAIN OUTCOME MEASURES: Processes of care (referrals, key management processes, time-based metrics) and clinical outcomes.RESULTS: Of 613 participants with possible TIAMS who completed the baseline interview, 298 were adjudicated as having TIAMS (119 from rural, 179 from metropolitan). Mean age was 72.3 years (SD, 10.7) and 127 (43%) were women. Rural participants were more likely to be managed solely by a general practitioner (GP) than metropolitan participants (34% v 20%) and less likely to be referred to a JHHANC specialist (13% v 38%) or have brain magnetic resonance imaging (MRI) [24% v 51%]. Those rural participants who were referred, also waited longer (both p 0.001). Recurrent stroke, myocardial infarction and death at 12 months were not significantly different between rural and metropolitan participants.CONCLUSIONS: Although TIAMS prognosis in rural settings where solely GP care is common is very good, the processes of care in such areas are inferior to metropolitan. This suggests there is further scope to support rural GPs to optimise care of TIAMS patients.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/172772