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Recording a diagnosis of stroke, transient ischaemic attack or myocardial infarction in primary healthcare and the association with dispensation of secondary preventive medication: a registry-based prospective cohort study
  1. Cecilia Dahlgren1,2,
  2. Lukas Geary3,4,
  3. Jan Hasselström5,6,
  4. Clas Rehnberg1,
  5. Karin Schenck-Gustafsson7,
  6. Per Wändell5,
  7. Mia von Euler3,8
  1. 1 Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
  2. 2 Stockholms Läns Landsting, Center for Health Economics, Informatics and Healthcare Research, Stockholm, Sweden
  3. 3 Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
  4. 4 Unit of Medicine, Capio S:t Görans Sjukhus, Stockholm, Sweden
  5. 5 Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
  6. 6 Stockholms Läns Landsting, Academic Primary Care Center, Stockholm, Sweden
  7. 7 Department of Medicine, Cardiac Unit, Center for Gender Medicine, Karolinska Institutet, Stockholm, Sweden
  8. 8 Department of Medicine, Clinical Pharmacology Unit Solna, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Cecilia Dahlgren; cecilia.dahlgren{at}ki.se

Abstract

Objectives The aim of this study was to explore whether recording in primary care of a previously recorded hospital diagnosis was associated with increased patient utilisation of recommended medications.

Design Registry-based prospective cohort study.

Setting and participants 19 072 patients with a hospital discharge diagnosis of transient ischaemic attack (TIA), stroke or acute coronary syndrome from hospitals in Stockholm County 2010–2013 were included in the study.

Main outcome measure The outcome of the study was medication dispensation as a marker of adherence to recommended medications. Adherence was defined as having had at least two filled prescriptions in the third year following hospital discharge.

Results Recording a diagnosis was associated with higher utilisation of all recommended medications with the exception of antihypertensives in patients with TIA. The differences between the groups with and without a recorded diagnosis remained after adjusting for age, sex, index year and visits to private practitioners. Dispensation of antithrombotics was high overall, 80%–90% in patients without a recorded diagnosis and 90%–94% for those with a diagnosis. Women with recorded ischaemic stroke/TIA/acute coronary syndrome were dispensed more statins (56%–71%) than those with no recorded diagnosis (46%–59%). Similarly, 68%–83% of men with a recorded diagnosis were dispensed statins (57%–77% in men with no recorded diagnosis). The rate of diagnosis recording spanned from 15% to 47% and was especially low in TIA (men 15%, women 16%).

Conclusion Recording a diagnosis of TIA/stroke or acute coronary syndrome in primary care was found to be associated with higher dispensation of recommended secondary preventive medications. Further study is necessary in order to determine the mechanisms underlying our results and to establish the utility of our findings.

  • primary care
  • quality in health care
  • preventive medicine
  • clinical pharmacology
  • myocardial infarction
  • stroke

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors CD: contributed to the study design, researched data, contributed to analysis and interpretation of data and drafted the manuscript. LG: contributed to the study design, researched the literature, contributed to analysis and interpretation of data and drafted the manuscript. CR, KS-G and PW: contributed to the study design, contributed to analysis and interpretation of data and critically revised the manuscript. JH and MvE: came up with the original idea, contributed to the study design, contributed to analysis and interpretation of data and critically revised the manuscript. All authors approved the final manuscript.

  • Funding Supported by grants provided by the Stockholm County Council (ALF project) and by the Stockholm Drug and Therapeutics Committee. Funding was provided as unrestricted grants. The funding bodies did not influence the work, the analyses or the interpretations, all which are the full responsibility of the authors.

  • Competing interests None declared.

  • Ethics approval The study was approved by the regional ethics review board in Stockholm, Dnr 2015/803-31/5 and Dnr 2016/1547-32.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional aggregate level data can be made available by emailing cecilia.dahlgren@ki.se.

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