Report finds Ontario’s stroke prevention clinics see less than half of high-risk patients within 7 days

A first-ever audit of Ontario’s secondary stroke prevention clinics (SPCs) indicates improvements in care and patient outcomes, but there are opportunities for improvement, and concern remains with respect to timely access to SPCs for urgent cases, says Christina O’Callaghan, Executive Director of the Ontario Stroke Network (OSN).

For the first time, researchers at the OSN and the Institute for Clinical Evaluative Sciences (ICES) examined the care provided at Ontario's 40 SPCs. Their report,Ontario Stroke Evaluation Report 2013: Spotlight on Secondary Stroke Prevention and Care, was published today by ICES and is available for download.

“Ontario SPCs have been successful in coordinating with emergency departments to ensure most patients referred to the clinics have their diagnostics completed and medications prescribed. This is significant because more than 80 per cent of referrals are elective or semi-urgent. However, more than 50 per cent of high-risk patients are not seen within one week, when there is the greatest opportunity to reduce the risk of a recurrent stroke,” says Ruth Hall, lead author of the report and adjunct scientist at ICES. Increasing evidence shows that a transient ischemic attack or minor stroke predicts a high risk of a more serious stroke, death or other cardiovascular events. Early diagnosis and intervention are crucial for prevention of another event.

The report found that:

• Less than half (47 per cent) of urgent patients are seen within a week of referral, and only 14 per cent are seen within the critical 72-hour period.
• There has been marked improvement in secondary prevention care compared to rates observed prior to the establishment of SPCs; 94 per cent of patients have required brain imaging and imaging of the carotid artery (84 per cent), and 80 per cent of patients with atrial fibrillation have anticoagulant therapy prescribed or recommended.
• For patients seen at SPCs, the median time to carotid revascularization exceeds the best-practice target of 14 days.

“The establishment of stroke prevention clinics in Ontario has revolutionized outpatient stroke care and decreased utilization of valuable hospital resources over the past decade,” says Dr. Demetrios Sahlas, the MG DeGroote Professor in Stroke Management at McMaster University and a stroke neurologist at Hamilton Health Sciences. “However, there is room for improvement in terms of standardizing protocols for triaging of patient referrals, and achieving best practices across the entire network of clinics.”  

Authors of the report include Ruth Hall, Ferhana Khan, Christina O’Callaghan, Moira K. Kapral, Kathryn Hodwitz, Shivali Kapila, Shudong Li, Jiming Fang, Limei Zhou and Mark Bayley.

The Ontario Stroke Network provides provincial leadership and planning for the Ontario Stroke System by measuring performance, partnering to achieve best practices and creating innovations for stroke prevention, care, recovery and reintegration.

For the latest OSN news, visit www.ontariostrokenetwork.ca.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION PLEASE CONTACT:

Deborah Creatura
Communications, ICES
[email protected]
(o) 416-480-4780