Decision support tool for minor stroke diagnosis rolled out

An electronic clinical decision support tool aimed at helping GPs to diagnose minor stroke has been funded by the NZ government for a free roll-out nationwide and is available through common practice management systems (PMSs).

The tool, developed by neurologist Anna Ranta in association with the MidCentral Stroke Service and Best Practice Advocacy Centre (BPAC), is aimed at helping to mitigate the problem of delayed referral to specialists of patients who have experienced transient ischaemic attack (TIA) or minor stroke.

The tool has been trialled in 56 general practices across the country, where it has shown improved outcomes for patients and reduced treatment costs.

Dr Ranta said the tool helps GPs to accurately diagnose TIAs, promoting treatment initiation at first point of contact rather than awaiting specialist review, and prompts GPs to manage TIA and stroke patients comprehensively and in accordance with New Zealand guidelines.

“In a nutshell, it uses a logic algorithm to assess likelihood of TIA/stroke diagnosis, seven-day stroke risk and then recommends evidence-based treatment options,” she said.

As part of the FASTEST trial, Dr Ranta and her team analysed general practice records and found that on average, GPs will be confronted four to five times a year with a patient with a presumed TIA/minor stroke.

However, diagnostic accuracy of TIA/minor stroke is only 50 to 80 per cent, the research found, so the actual rate of recognised presentations may be as few as two to three patients per year.

To help GPs better diagnose and manage TIAs, BPAC is hosting the tool as a module on its website, which is accessible to GPs through the BPAC button in the navigation bar of their PMS.

From there they can select the TIA/stroke tool from a menu, which then displays a single page of tick boxes to complete covering relevant aspects of presenting illness history and a brief focused physical examination.

Relevant past medical history is automatically populated by extracting data directly from the PMS.

The background tool takes between two to five minutes to complete, and based on the information provided, the software confirms or rejects TIA/stroke as the likely diagnosis.

If TIA or stroke is confirmed, a triage recommendation is generated based on the validated ABCD2 risk score.

Dr Ranta, who developed the technology while working as a consultant neurologist at Palmerston North Hospital and associate dean of undergraduate medical education at the University of Otago, Wellington, has now moved to the Capital & Coast District Health Board (DHB).

Posted in New Zealand eHealth

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