New evidence in general practice, internal medicine and cardiovascular medicine

Abstract

The results of a United Kingdom prospective population based study suggest that the opening hours of general practices influence the behavior of a large number of patients suffering from minor stroke or transient ischemic attack (TIA) occurring out of hours. Transient ischemic attacks are transient short-lasting neurological events. However, even if the majority of the symptoms of TIAs disappear within 60 min, they can go on up to 24 h. Minor strokes and TIAs are emergencies related to a notable risk of recurrence and recent research indicates that diagnosis and management of minor strokes and TIAs within 24 h from their insurgence can significantly lower the risk of recurrent stroke. Nine general practices in the United Kingdom were analysed in the context of a population based prospective study, to evaluate the fall out of general practice opening hours on the behavior in looking for health care on the part of individuals suffering from minor stroke or TIA. The study also assessed the sustainability of clinical evaluation within 24 h from the insurgence of the symptoms. More than 400 (434) subjects with minor stroke and 359 individuals with TIA were considered, and the median time before the call of a general practitioner (GP) in the course of surgery hours was 4 h; approximately two patients out of three (68%) with neurological episodes in the course of surgery hours called doctors within 24 h from the insurgence of symptoms. The median time before the call of the emergency general practitioner service was 1 h, while it was 24.8 h for subjects waiting to call their registered practice (p 0.001). In individuals who suffered from neurological episodes out of hours, and waiting to contact their GP, the seeking for medical care was inferior for episodes occurring in weekends than in weekdays (odds ratio 0.10). The majority of patients suffering from minor stroke or transient ischemic attack out of hours, in particular in the course of the night or during the weekends, registered a delay in looking for medical care, waiting for the opening hours of their GP. The results of this prospective population based study therefore suggest that the opening hours of general practices influence the behavior of a large number of patients suffering from minor stroke or transient ischemic attack occurring out of hours.