Primary Stroke Prevention: Comparison of Information Sharing Preferences of At-risk Patients with Family Physicians’ Practices
Stroke is the second leading cause of death and the third leading cause of disability worldwide.1 In Canada, 62,000 people are affected by stroke and transient ischemic attacks (TIA) each year.2 In Ontario alone, 17,500 patients were admitted in 2016-2017 for stroke or TIA.3 As a result of improved stroke survival rates, more than 400,000 Canadians are currently living with long-term disability from stroke, and this number will almost double in the next 20 years.4,5 Stroke can be prevented in patients with modifiable risk factors such as hypertension, high cholesterol and atrial fibrillation. These conditions account for up to 90% of stroke risk.10 Management of these risk factors is an effective method for reducing stroke incidence and mortality.11
National and international trials indicate that amongst the general population, knowledge of risk factors, signs, symptoms, and management of stroke is inadequate.6,7 Inadequate health literacy is a major barrier to effective prevention, screening and treatment of disease, leading to mortality and reduced quality of life.8,9
Family physicians (FPs) have been identified as the primary source of health information for patients.12 Family physicians are uniquely situated to assess stroke risk before the first stroke and initiate preventive strategies for at-risk patients.4,13 The continuity of care in general practice permits an ideal environment for long-term primary prevention efforts. However, evidence from the Heart & Stroke Foundation of Canada shows that physicians lack time and skills to counsel patients about lifestyle modifications.14
The Canadian Stroke Best Practice Recommendations suggest a coordinated approach to public awareness and education of stroke and its risk factors.2 Prevention of stroke requires active patient participation using a multimodal strategy resulting in improved stroke and health literacy and sustained behavioural changes.10 While literacy may be promoted through individual, local or national initiatives, information gained from the FP can be a valuable tool for the foundation of lasting change. However, there is sparse literature on the current quality of communication between FPs and patients regarding stroke risk based on patient risk factors.
Our study is unique as it includes the perspectives of patients at-risk, stroke survivors and FPs. More specifically, we examine these groups to establish how family physicians communicate with patients at-risk who have never had a stroke. Previous studies have investigated these groups independently and focused on secondary prevention. Our study identifies gaps in patient education across the GTA and communication about primary stroke prevention.
Capstone Advisory Committee: