Objective: With the physician training program and stroke clinic, the gap between clinical practice and the guideline for secondary prevention of ischemic stroke can been narrowed.
Methods: 305 patients with ischemic stroke were enrolled in a stroke clinic after their discharge from the hospital. Among the 305 patients, 87 were discharged before the institution of a physician training program (pre-training group) and 218 after the institution (post-training group). Their usage of antithrombotic agents, statins, non-standardized therapies and antihypertensive agents were compared at the time of discharge from the hospital and follow-up in the stroke clinic comparison was also made for the two groups of patients discharged before and after the physician training program.
Results: After the physician training program, implementation rates increased for antithrombotic agents (79.3% vs 93.1%, P < 0.01) and statins (19.5% vs 59.2%, P < 0.01), using of non-standardized therapies decreased (47.1% vs 27.5%, P = 0.001), but no change was found for using of antihypertensive agents (88.4% vs 94.0%, P > 0.05). Comparing with the usage of medications at the time of discharge, the usage of antithrombotic agents and statins after discharge i,e. in the stroke clinic were further increased (for antithrombotics, in the pre-training group 79.3% vs 86.2%, P = 0.229, in the post-training group 93.1% vs 94.0%, P = 0.696; for statins, in the pre-training group 19.5% vs 39.1%, P = 0.005, in the post-training group 59.2% vs 69.7%, P = 0.021), while the usage of non-standardized therapies decreased further (in the pre-training group 47.1% vs 17.2%, P < 0.01, in the post-training group 27.5% vs 14.2%, P = 0.001). Implement of guideline at discharge influenced the compliance as the patients with high rates of usage of antithrombotic agents and statins at the time of discharge had also high rates of the usage of them at follow-up in the stroke clinic.
Conclusions: Physician training program increases the implement of the guideline for secondary stroke prevention and stroke clinic can improve the compliance with it. Usage of medications at the time of discharge influences the compliance with them during the follow-up period.