Attitudes and Current Practice of Primary Care Physicians in Acute Stroke Management

Abstract

Stroke patients often report that primary care physicians (PCPs) are their first medical contact after onset of symptoms. We studied PCP attitudes and current practice in early management of suspected stroke patients. A cross-sectional survey was conducted among 714 general practitioners, internists, and neurologists providing acute primary care for stroke patients in 4 different regions in Germany. PCP attitudes and practices were assessed with standardized questionnaires and case vignettes presenting suspected stroke patients contacting PCPs either by phone or in practice. Factors influencing the decision of the PCPs to admit patients with clear stroke symptoms as medical emergency to hospital were assessed using multivariate analysis. In total, 395 PCPs participated in the study (55.3%). Most PCPs agreed that stroke (94.7%) and transient ischemic attack (84.8%) were medical emergencies. In case vignettes, admission to hospital as medical emergency was preferred management after first contact to patients with clear stroke symptoms by phone or in practice (68.9% and 65.6%, respectively). Outpatient clarification was the preferred option of PCPs in patients with unclear stroke symptoms contacting PCPs by phone or in practice (54.7% and 75.5%, respectively) and in transient ischemic attack patients (50.9%). Working as general practitioner (odds ratio, 0.3; 95% confidence interval, 0.2 to 0.6) and practice location outside metropolitan area (P=0.002) independently decreased probability of admitting suspected stroke patients as medical emergency when first contact to PCPs was by phone. PCP agreement that all stroke and transient ischemic attack patients must be admitted to hospital increased probability for early hospitalization of stroke and transient ischemic attack patients when first contact was in practice (odds ratio, 2.0; 95% confidence interval, 1.2 to 3.3, and odds ratio, 1.8; 95% confidence interval, 1.1 to 2.8, respectively). Stroke and transient ischemic attack were well recognized as medical emergencies by PCPs in our study. However, only two-thirds of PCP would immediately admit stroke suspected patients with clear symptoms to hospital as medical emergency.