• Johan S de Koning, Niek S Klazinga, Peter J Koudstaal, Ad Prins, Diederik W J Dippel, Jan Heeringa, Ruud P Kleyweg, NevenArie KnuistinghAK, Jan W Van Ree, Gabriel J E Rinkel, and Johan P Mackenbach.
• Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. j.s.dekoning@amc.uva.nl
• Prev Med. 2004 Feb 1; 38 (2): 129-36.

BackgroundIn identifying opportunities to improve the quality of stroke prevention in general practice, insight in areas of suboptimal care is essential. This study investigated the quality of care in stroke prevention in general practice and its relation to the occurrence of stroke.MethodsRetrospective case-based audit with guideline-based review criteria and final judgment of suboptimal care by an expert panel.ResultsA total of 292 stroke patients were identified through stroke registers of two main referral hospitals for stroke in Rotterdam. The general practitioners (GPs) (n = 95) of these patients were approached. The overall response rate from GPs was 81%, and a total of 193 patients from 77 GPs were included in the study. Data on the process of care at patient level were collected by chart review and by structured interviews with GPs during site visits. All cases were presented to a six-member panel of GPs and neurologists. In 44% of the cases, suboptimal care was identified (31% judged as possibly or likely failing to prevent stroke). Of the total number of identified shortcomings, 52% was related to inadequate hypertension control, particularly lack of follow-up after established hypertension. Another 17% of identified shortcomings concerned inadequate cardiovascular risk assessment.ConclusionsA substantial number of shortcomings in care, particularly in the domain of hypertension control and the assessment of patient's risk profiles for cardiovascular disease (CVD), were identified. This study suggests that improving preventive care delivery in general practice could reduce the occurrence of stroke.

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