Secondary Prevention Three and Six Years after Stroke Using the French National Insurance Healthcare System Database

2018 ◽  
Vol 79 (5-6) ◽  
pp. 272-280 ◽  
Author(s):  
Laura Mechtouff ◽  
Julie Haesebaert ◽  
Marie Viprey ◽  
Valérie Tainturier ◽  
Anne Termoz ◽  
...  
Keyword(s):  
Health Care ◽  
Secondary Prevention ◽  
Stroke Unit ◽  
Medication Use ◽  
Preventive Treatment ◽  
Continuous Measure ◽  
National Insurance ◽  
Health Care Funding ◽  
Study Population ◽  
Ischemic Attack

Background: Secondary prevention is inadequate in the first 2 years after stroke but what happens after that is less documented. The aim of this study was to assess the use and the adherence to preventive drugs 3 and 6 years after experiencing a transient ischemic attack (TIA) or an ischemic stroke (IS). Methods: The population study was from the AVC69 cohort (IS or TIA admitted in an emergency or stroke unit in the Rhône area, France, for an IS or a TIA during a 7-month period). Medication use was defined as ≥1 purchase during the studied year and adherence as Continuous Measure of Medication Acquisition ≥0.8 using the French medical insurance health care funding database. Results: The study population consisted of 210 patients at 3 years and 163 patients at 6 years. Medication use at 3 and 6 years was, respectively, 80.9 and 79.8% for antithrombotics, 69.1 and 66.3% for antihypertensives, 60.5 and 55.2% for statins and 48.6 and 46.6% for optimal treatment defined as the treatment achieved by the use of the 3 drugs. Adherence to each class was good at 3 years and tends to decrease at 6 years. Conclusions: More than one patient out of 2 do not use the optimal preventive treatment.

scholarly journals Two-State Kinetic Model of Rates of Stroke Recurrence in the POINT Study Population

Stroke ◽  
2021 ◽  
Author(s):  
James R. Brorson ◽  
Zachary B. Bulwa
Keyword(s):  
Ischemic Stroke ◽  
Kinetic Model ◽  
Secondary Prevention ◽  
State Transitions ◽  
Stroke Recurrence ◽  
Control Group ◽  
Rapid Rate ◽  
Minor Ischemic Stroke ◽  
Study Population ◽  
Ischemic Attack

Background and Purpose: Following an acute ischemic stroke or transient ischemic attack, 2 rates of stroke recurrence are suggested by data from trials of acute secondary prevention treatments: a transient rapid rate followed by a persisting slower rate of stroke. Methods: A kinetic model was constructed based on underlying vulnerable and stabilized states of patients following acute ischemic events related by fixed transition rates. Its predictions were fitted by nonlinear regression to the observed timing of outcome events in patients in the POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke). Results: The modeled survivor function produced a close fit to the observed data. The model's predicted kinetic rates suggest that, among subjects in the control group, the event rate was 100-fold higher in the vulnerable state than in the stabilized state. Active treatment halved this rapid rate and had little effect on event rates in the stabilized state. If at least one-tenth of the study population began in the vulnerable state, the rate of transition from the vulnerable to the stabilized state was still faster, with a half-life of only 1 to 2 days. Conclusions: Examination of kinetics of stroke occurrence, and of the rates associated with modeled state transitions, may provide insights into the underlying pathophysiological events that are targets for acute secondary prevention of stroke.

2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

2017 ◽  
Vol 12 (3) ◽  
pp. 302-320 ◽  
Author(s):  
Yongjun Wang ◽  
Ming Liu ◽  
Chuanqiang Pu
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Evidence Based ◽  
Cerebrovascular Disorder ◽  
Level Of Evidence ◽  
Vascular Stenosis ◽  
Ischemic Attack

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

Dresdener Network Osteoporosis

2020 ◽  
Author(s):  
Tim Fülling ◽  
Philipp Bula ◽  
Alexander Defèr ◽  
Felix Alois Bonnaire
Keyword(s):  
Health Care ◽  
Secondary Prevention ◽  
Health Care Systems ◽  
Trauma Surgery ◽  
Specific Treatment ◽  
Fragility Fractures ◽  
Osteoporosis Treatment ◽  
Prevention Programs ◽  
Global Scale ◽  
Limited Mobility

Abstract Purpose On a global scale the main focus of traumatological therapy lies in the treatment of unintentional injuries or victims of violence. People of all ages and through all economic groups can be affected. Due to demographic change in Western industrial countries, however, this focus increasingly shifts towards fragility fractures. In Europe osteoporosis is the most common bone disease in advanced age. Secondary prevention programs like the Fracture Liaison Service (FLS) are becoming increasingly prevalent, especially in Anglo-American health care systems. In German orthopedic and trauma wards and hospitals, however, the FLS is still relatively uncommon. This article will examine the question whether secondary prevention programs like FLS need to be established in the German health care system. This study aims at finding out, whether in the area of a medium sized German city there is a difference regarding the initiation of osteoporosis diagnosis and therapy between the regular aftercare by the general practitioner or the orthopedic surgeon and the aftercare by a specialist trained in osteology (Osteologe). Materials and Methods For the open, randomized prospective study 70 patients with low energy fractures were recruited, who were older than 60 years and have been treated in our department. Results 58 out of 70 patients have completed the study, which amounts to a follow-up of 82.9%. Limited mobility and a high degree of organizational effort were the main reasons for early termination of the study. While in the group with regular aftercare, only 2 out of 29 patients received a specific osteoporosis treatment, in group who were directly transferred to a specialist trained in osteology 17 out of 29 patients received specific treatment. After re-evaluation of group with regular aftercare in 21 out of 29 cases a specific osteoporosis treatment was recommended. Conclusions It could be established that there is a significant diagnosis and treatment gap regarding the aftercare of patients with fractures caused by osteoporosis between general practitioners or orthopedic surgeons on the one hand and the specialists trained in osteology on the other hand. To improve the aftercare of fracture patients, cross sectoral networks with a background in geriatrics and orthopedic-trauma surgery like a FLS need to be established in the German healthcare system.

Abstract 247: A Randomized Controlled Study of a Platform to Maximize Patient Knowledge of Health Goals After Acute Myocardial Infarction

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Robin Mathews ◽  
Peter Shrader ◽  
Vladimir Demyaneko ◽  
Vincent Miller ◽  
Laura Webb ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Secondary Prevention ◽  
Outpatient Visit ◽  
Medication Use ◽  
Treatment Goals ◽  
Post Discharge ◽  
Risk Factor Control ◽  
Health Goals ◽  
Education Tool

Objectives: Patients vary in the degree to which they understand and engage in their health care. We hypothesized that a personalized patient health education tool will promote patient communication and align patient and provider treatment goals in follow-up visits in order to optimize guideline adherence, including evidence-based therapy use and cardiovascular risk factor control, after an acute myocardial infarction (AMI). Methods: We developed a personalized patient education tool that summarized each patient’s status at discharge of secondary prevention risk factors (blood pressure (BP), low density lipoprotein cholesterol (LDL-C) and glycemic control), medication use (aspirin, beta blocker, ACE inhibitor/ARB, statin, P2Y 12 inhibitor), and outpatient treatment goals. Patients were randomized 1:1 to usual care vs. receipt of the education tool within 2 weeks post-discharge (before the outpatient visit). We compared secondary prevention medication use, cardiovascular risk factor control, and awareness of treatment goals between randomized groups at 6 months post-discharge. Results: Among 192 enrolled AMI patients, the median age was 60 years, 42% female, and 35% African American; demographic and clinical characteristics were well balanced between randomized groups. We noted high rates of secondary prevention therapy use at 6 months (Table). By 6 months post-discharge, mean systolic BP decreased by 10 mmHg with 80% of patients <140/90 mmHg, and mean LDL-C decreased by 13 mg/dl with 64% of patients under 100mg/dl. Overall, 36% of patients participated in cardiac rehabilitation. We observed no significant differences between randomized groups in any of these outcomes. Only 9% of patients who received the education tool brought it to their outpatient visit for discussion. Conclusion: Though secondary prevention medication use remains reasonably high at 6 months, achievement of secondary prevention health goals remains suboptimal after a myocardial infarction. Few patients utilized the health tool in discussions with outpatient providers during their follow-up visit which likely explains the lack of outcomes differences between randomized groups. Further work is needed to find effective interventions to engage patients and promote sustained behavioral modification for secondary prevention.

Promoting Healthy Medication Use Through Indigenous Knowledge Sharing: A Coyote Story

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Gina Gaspard ◽  
Carrie Gadsby ◽  
Cindy Preston
Keyword(s):  
Health Care ◽  
Knowledge Sharing ◽  
First Nations ◽  
Indigenous People ◽  
Health Authority ◽  
Health Care Professionals ◽  
Claims Data ◽  
Medication Management ◽  
Medication Use ◽  
Care Services

Polypharmacy is the administration of more medications than clinically required or appropriate, and it can negatively impact wellness. Prescribers, pharmacists, nurses, and those receiving care services all have an important role to play in promoting healthy medication use and minimizing the risk related to polypharmacy. Medication management involves health care professionals regularly reviewing drug therapies with patients for any needed changes. This strategy is a key way to reduce the harms of polypharmacy. A review of the First Nations Health Authority Health Benefits Claims data in 2015 confirmed that polypharmacy is an issue for First Nations in British Columbia, Canada. This was further validated in a series of meetings held in four First Nations communities. The learnings from these meetings were that many people do not know the names of their medications, the reasons for taking them, or how to advocate for themselves during health care interactions. A unique strategy was needed to both encourage and empower First Nations and Indigenous people to discuss managing their medications, and to support health care professionals to better understand how to engage First Nations patients about their medications.

scholarly journals An Opportunity for Pharmacists to Help Improve Coordination and Continuity of Patient Health Care

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 78 ◽  
Author(s):  
Jon Schommer ◽  
Lawrence Brown ◽  
Ryan Bortz ◽  
Alina Cernasev ◽  
Basma Gomaa ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care System ◽  
Medication Use ◽  
The United States ◽  
Patient Health ◽  
Consumer Perspective ◽  
Medication Experience ◽  
Pharmacist Workforce ◽  
Care System

Pharmacist workforce researchers are predicting a potential surplus of pharmacists in the United States that might result in pharmacists being available for engagement in new roles. The objective for this study was to describe consumer opinions regarding medication use, the health care system, and pharmacists to help identify new roles for pharmacists from the consumer perspective. Data were obtained from the 2015 and 2016 National Consumer Surveys on the Medication Experience and Pharmacist Roles. Out of the representative sample of 36,673 respondents living in the United States, 80% (29,426) submitted written comments at the end of the survey. Of these, 2178 were specifically about medicines, pharmacists or health and were relevant and usable for this study. Thematic analysis, content analysis, and computer-based text mining were used for identifying themes and coding comments. The findings showed that 66% of the comments about medication use and 82% about the health care system were negative. Regarding pharmacists, 73% of the comments were positive with many commenting about the value of the pharmacist for overcoming fears and for filling current gaps in their healthcare. We propose that these comments might be signals that pharmacists could help improve coordination and continuity for peoples’ healthcare and could help guide the development of new service offerings.

scholarly journals A school-based oral health educational program: the experience of Maringa- PR, Brazil

2004 ◽  
Vol 12 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Carlos Alberto Conrado ◽  
Sandra Mara Maciel ◽  
Márcia Regina Oliveira
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Oral Hygiene ◽  
Primary Schools ◽  
Oral Health Care ◽  
School Level ◽  
Educational Approach ◽  
Entire Study ◽  
School Based ◽  
Study Population

The main purpose of this study was to evaluate the preliminary results of a school-based oral health educational strategy adopted in public primary schools from the city of Maringa, State of Parana, Brazil. The study sample was composed by 556 children and adolescents aged 6 to 17 years old, 124 schoolteachers and a group of 55 mothers. The educational approach was implemented for 18 months and consisted of reinforcements of interventions addressed to students and schoolteachers at school level and few activities targeted at the mothers, performed by means of home visits. Baseline and follow-up interviews focused on oral health care were undertaken for the entire study population. As a stimulus for the students to achieve proper oral hygiene habits, the simplified oral hygiene index was assessed at three different moments. A statistically significant improvement in their oral hygiene index (p<0.001) was recorded. The results achieved suggest an encouraging tendency towards the improvement in the levels of oral health care among the school-age youths studied. They also point out the need of intensifying the preparation of schoolteachers in oral health topics, as well the instructions to the mothers for their oral health care. Moreover, they highlight the importance of the continuous implementation of school-based programs to promote the oral health.

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