Implementing a responsive TIA model of care with embedded longitudinal capabilities.

Abstract

BACKGROUND & AIMS: Instituting a new TIA service that incorporates all ideal elements is challenging due to system constraints. The service must combine early comprehensive assessment with integrated long-term follow up that promotes sustained adherence to stroke prevention strategies. METHOD: In Australia at Epworth Eastern, a new rapid assessment service for patients suspected of having TIA opened in 2016. With no inhouse Emergency Department (ED), direct admission occurred via a 24 hour hotline available to primary care and ED physicians. on discharge, planned telephone contact at 1, 6, 12, 26 and 52 weeks was made by the stroke specialist nurse. Patients were also booked for review with neurologists. This co-ordinated approach was designed to facilitate continual reinforcement of secondary prevention strategies. Data were collected from February to December 2016. RESULTS: Sixty patients were admitted with subsequent diagnosis of TIA or confirmed stroke. Successful telephone follow up occurred in 75%. Among these, 15% had cancelled neurologist appointments but agreed to ongoing telephone follow up. At 6 months, 75% (N=34) of patients remained on prescribed stroke prevention medication. Antihypertensives were the most frequently ceased medications with (N=5) patients recording "dizziness" as the reason for cessation. 50% were adhering to recommended lifestyle modifications for stroke prevention. Diet and exercise advice were the commonest aspects of nonadherence. One patient has had a subsequent stroke (1.6%). CONCLUSION: The benefits of effective stroke prevention could be maximally realised through a TIA model of care that places stronger emphasis on rapid comprehensive assessment and efficient, structured, longitudinal follow up.