Physician Attitudes towards Acute Stroke – A Comparison of Primary Care Physicians in Iowa and The Netherlands

Abstract

Randomly selected primary care physicians in Iowa (n = 250) or The Netherlands (n = 250) received a questionnaire asking their opinions about management of patients with ischemic stroke of recent onset (ISRO). Responses were received from 64% of the Dutch and 58% of the Iowa physicians. More physicians in Iowa (81 %) considered ISRO a medical emergency similar to myocardial infarction than their Dutch colleagues (51 %) (difference: 30%; 95% confidence limits (CL): 20–40%). More Iowa physicians also thought ISRO was a treatable condition (72 vs. 48%; difference: 24%; CL: 13–35%), but only if management began within a few hours of onset of symptoms (76 vs. 45%; difference: 31 %; CL: 21–41 %). When asked about potentially useful drugs for ISRO, Dutch physicians favored thrombolytic drugs (45 vs. 33%; difference: 12%; CL: 1–23%) or steroids (33 vs. 18%; difference: 15%; CL: 5–25%), whereas the Iowa physicians more often considered heparin potentially useful (76 vs. 30%; difference: 46%; CL: 36–56%). Admission to the hospital for most patients with ISRO was thought to be appropriate by 97% of the Iowa and 48% of the Dutch physicians (difference 49%; CL: 41–57%). More physicians in Iowa refer patients with ISRO to hospitals with special expertise in stroke (46 vs. 10%; difference: 36%; CL: 27–45%). Also, more Iowa physicians refer to hospitals where promising treatments are being tested (35 vs. 7%; difference: 28%; CL: 19–37%). In planning of multicenter clinical trials attention should be paid to the consequences of variations in the organization of health care systems in different countries. Primary care physicians should be regularly informed about their key role in the early management of patients with ISRO, particularly in situations which involve testing of new or promising therapies. Our results indicate that primary care physicians in The Netherlands should be stimulated to collaborate in such efforts similar to that reported by their Iowa colleagues.

Patients, Centres, Admission Procedures and Non-Randomized Treatments around the World

“…There are also important varia tions in perceptions about stroke by referring family doc tors in different countries concerning potentially useful drugs, and their willingness to refer patients to trials centres. This underscores the importance of educating and involving family doctors in stroke trials [26].…”

“…Of relevance to patient accrual in acute stroke trials are the prevalent non-randomized acute stroke therapies al ready in use, most of unproven value [27], There are sig nificant differences in attitudes of both treating specialists and primary care doctors in different countries, which can impact on the organization of international stroke trials [26], Heparin is the major therapy used in acute stroke, outside of clinical trials, around the world. In most coun tries, it is frequently used in cardioembolic stroke, pro gressive or basilar-territory infarction.…”