Community physicians’ knowledge of secondary prevention after ischemic stroke: a questionnaire survey in Shanxi Province, China

Chen et al. BMC Medical Education Community physicians' knowledge of secondary prevention after ischemic stroke: a questionnaire survey in Shanxi Province, China Chen Chen 0 1 Xiaoyuan Qiao 1 2 Huijie Kang 0 1 Ling Ding 0 1 Lixia Bai 0 1 Jintao Wang 0 1 0 Department of Epidemiology, School of Public Health, Shanxi Medical University , Taiyuan, Shanxi Province , China 1 Location of practicing >20 years P value 2 Department of Geriatrics, The Third People's Hospital of Shanxi Province , Taiyuan, Shanxi , China Background: This cross-sectional, questionnaire-based survey, conducted in Shanxi Province, China, evaluated the knowledge of community physicians of secondary prevention of ischemic stroke and transient ischemic attacks (TIAs). Results: Over 90 % of participants were aware of the most common risk factors for stroke, but lifestyle-related factors were seen as of low or medium importance for secondary prevention. Only about 50 % of physicians were aware of the existence of commonly used stroke scales, and fewer said that they would use those scales in their clinical practice. There were slight differences in the responses to some of the questions on risk factors and stroke scales were associated with the physicians' gender, academic qualifications, practice duration and location. Less than half of the participants were aware of the secondary prevention recommendations included in the most recent guidelines. Conclusion: The survey revealed a huge gap in knowledge of current guidelines for secondary prevention of ischemic stroke and TIA among the physicians surveyed. Continuing education and training of community physicians, administered as a public health program, is needed to improve the healthcare of ischemic stroke and TIA patients. Ischemic stroke; Transient ischemic attack; Secondary prevention; Community physician - Background The mortality of ischemic and hemorrhagic stroke is decreasing worldwide, resulting in an increase in the number of stroke survivors, especially in low- and middle-income countries [1]. Patients who have had an ischemic stroke or transient ischemic attack (TIA) have a high risk of recurrence; and in Western countries, approximately 8–12 % of patients experience a second event within the first year after a stroke or TIA [2, 3]. The National Stroke Registry of China reported that 17.7 % of 11,560 patients with ischemic stroke or TIA, experienced a recurrence within 1 year [4]. This geographical difference may be partly explained by the relatively high prevalence of intracranial large-artery disease in the Chinese compared with Western populations and the particularly high risk of recurrent ischemic stroke with that etiology. On the other hand, it might also be attributed to gaps in the professional education of practicing physicians and their familiarity with current guidelines for secondary prevention in China [5]. Such gaps would hinder timely and accurate risk evaluation, stratification, and optimal medical management, as well as the best use of antiplatelet, anticoagulant, or interventional/surgical therapies, which are all important for secondary prevention. Improved knowledge and awareness would be expected to result in a reduced risk of recurrence in stroke patients [6, 7]. A large, nationwide survey of secondary stroke prevention, conducted in 3489 Chinese general physicians and neurologists, reported a lack of adequate awareness of © 2015 Chen et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Fig. 1 Box-and-whisker plots showing the importance of individual risk factors of ischemic stroke as rated on a scale from 1 to 9 by community physicians, with 9 as most important. CAD, coronary artery disease; TIA, transient ischemic attack; LDL-C, low-density lipoprotein cholesterol the Chinese National Guidelines for Prevention of Ischemic Stroke and Transient Ischemic Attack [8] The survey participants were either general practitioners or specialists [5], but their responses did not accurately represent the level of professional knowledge that many practicing Chinese community physicians have. For example, in Shanxi Province, located in the center of the Yellow River Valley of northern China, all community physicians are involved in the care of stroke patients. However, little is known of their knowledge of the aspects of stroke relevant to recurrence, and no standardized training or continuing education programs in the area of stro (...truncated)