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
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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
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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)