Transient ischaemic attacks clinics provide equivalent and more efficient care than early in-hospital assessment
| Autor: | Patricia Martínez-Sánchez, Gerardo Ruiz-Ares, Blanca Fuentes, Rubén Cazorla-García, E. Correas-Callero, Exuperio Díez-Tejedor, M. M. Martínez-Martínez, Manuel Lara-Lara |
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| Rok vydání: | 2012 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty MEDLINE Transient ischaemic attacks Ambulatory Care Facilities Risk Factors parasitic diseases Secondary Prevention Humans Medicine Prospective Studies cardiovascular diseases Medical diagnosis Disease management (health) Risk factor Prospective cohort study Stroke Aged business.industry Disease Management Health Care Costs medicine.disease Hospitalization Outcome and Process Assessment Health Care Neurology Ischemic Attack Transient Emergency medicine Etiology Female Neurology (clinical) business |
| Zdroj: | European Journal of Neurology. 20:338-343 |
| ISSN: | 1351-5101 |
| DOI: | 10.1111/j.1468-1331.2012.03858.x |
| Popis: | Background and purpose Clinics for early management of transient ischaemic attacks (TIAs) have been developed in some stroke centres, resulting in reduced recurrence rates compared to appointment-based outpatient management, thus saving on hospitalization. We analysed the care process, recurrence rates and economic impact of the first year of work in our early-management TIA clinic and compared these with our previous in-hospital study protocols for low- and moderate-risk TIA patients. Methods This was a prospective evaluation of the management of low- to moderate-risk TIA patients, comparing a new TIA clinic model (2010) with a previous hospitalization model (2009). Demographic data, vascular risk factor profiles, diagnostic test performance, secondary prevention measures, final aetiological diagnoses and cerebrovascular recurrences at 7 and 90 days were compared between in-hospital and TIA clinic assessed patients. We also carried out an economic comparison of the costs of each model's process. Results Two hundred and eleven low- to moderate-risk TIA patients were included, of whom 40.8% were hospitalized. There were no differences between the TIA clinic assessed and in-hospital assessed patients in terms of risk factor diagnosis and secondary prevention measures. The stroke recurrence rate (2.4% vs. 1.2%; P = 0.65) was low and similar for both groups (CI 95%, 0.214–20.436; P = 0.52). Cost per patient was €393.28 for clinic versus €1931.18 for in-hospital management. Outpatient management resulted in a 77.8% reduction in hospitalizations. Conclusion Transient ischaemic attacks clinics are efficient for the early management of low- to moderate-risk TIA patients compared to in-hospital assessment, with no higher recurrence rates and at almost one-fifth the cost. |
| Databáze: | OpenAIRE |
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