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January2013 Vol.50 Issue:      1 Table of Contents
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A Study of Knowledge of TIA's in Primary Care Practice in Ismailia Governorate, Egypt

Mosleh A. Ismail1, Mohamed E. Negm2

Departments of  Family Medicine1, Neurology2, Suez Canal University; Egypt

 



ABSTRACT

Background: Patients with transient ischemic attack (TIA) need early assessment and management, they frequently first contact their family physician (FP)/ general practitioner (GP) rather than seeking care at a hospital. Objective: To assess knowledge and practices of primary health care physicians in Ismailia governorate regarding TIA. Methods:  This is cross sectional study conducted on all the primary health care units and centers in Ismailia governorate. All the studied physicians (130) were subjected to structured interview but only 101 physicians were accepted to participate. There were some missed data in 6 questionnaires, so, the total number was 95. Their background knowledge and practices regarding TIA were assessed. A developed questionnaire was used in the structured interview with working primary health care physicians. Results: Majority of physicians identified correctly most of symptoms consistent with TIA while 35% choice symptoms not consistent with TIA. Only 21% identified duration of symptoms of TIA according to the recent definition (1 hour). One fourth of them were not knowledgeable about which diagnostic test to start with. Only 43.2% have conducted screening for TIA. Only one third of them decided to refer patient with current TIA to hospital. However 48.4% decided to control risk factors for patients with history of TIA. More than 26% of them prescribed inappropriate treatment, 13.7% of the studied physicians did not refer TIA patient to neurologist. Conclusion: Knowledge and practices of primary health care physicians regarding TIA was unsatisfactory, training courses periodically is of utmost importance. [Egypt J Neurol Psychiat Neurosurg.  2013; 50(1): 5-12]

Key Words: TIA, Knowledge, Practices

Correspondence to Mohamed Negm, Department of Neurology, Suez Canal University, Egypt.Tel: +201005641148    e-mail: mohnegm2@yahoo.com




 

INTRODUCTION

 

Transient ischemic attack (TIA) defined as attacks of focal neurological dysfunction resulting from cerebral ischemia. Traditionally, TIAs were defined as any focal cerebral ischemia with symptoms lasting <24 hours. Recently newer definition of TIA developed that is “a brief episode of focal neurological dysfunction caused by brain or retinal ischemia lasting less than one hour, and without evidence of acute infarction”1.

The prevalence of TIA founded to be 2.7% for 65 to 69 years of age and 3.6% for 75 to 79 years of age in men. For women, TIA prevalence was 1.6% for 65 to 69 years of age and 4.1% for 75 to 79 years of age2. Among adults 45 to 64 years the prevalence of TIAs was found to be 0.4%3.

Among patients who present with stroke, the prevalence of prior TIA has been reported to range from 7% to 40%4,5. By time, the stroke risk was 8% at 1 week, 11.5% at 1 month, and 18.2% at 3 months following a TIA6. Approximately 85% of the strokes that follow a TIA are fatal or disabling7. Early intervention following TIA may reduce the risk of stroke by up to 80%8,9. However, half of the strokes that

 

follow a TIA occur in the first 48 hours6,7,10, so, the time window for intervention is brief and awareness and rapid management are the real challenges of TIAs.

The role of the family physician (FP) or general practitioner (GP) can be significant in the assessment and management of transient ischemic attacks (TIAs). TIA patients may regard their symptoms with less urgency and present to primary care, and the diagnosis can be a difficult one. Increasing evidence supports early urgent assessment and management of TIAs to prevent subsequent stroke.

There are currently no formal pathways for TIA care and it is unclear how FPs/GPs manage patients who present with suspected TIA. There have been some studies that have assessed the knowledge of FPs/GPs on stroke and TIA management. Middleton et al (2003) assessed GPs’ knowledge regarding risk factors of TIA/stroke, stroke prevention and management in New South Wales11. They concluded that GPs required more purposeful and effective education in this regard.

There are few data available addressing how suspected TIA patients are diagnosed, evaluated and treated by FPs/GPs. The current study is aiming to assess knowledge and practices of primary health care physicians in Ismailia Governorate regarding TIA. Also, to identify factors that might affect practicing screening for TIA.    

SUBJECTS AND METHODS

 

This is a cross-sectional study. It was conducted on all primary health care physicians (PHCPs) working in primary health care units/centers affiliated to Ministry of Health and Population (MOHP) in Ismailia Governorate. The total number of working physicians at the time of conducting the study was (130). A Transient Ischemic Attack (TIA) questionnaire was developed and used as a tool to evaluate the knowledge and practices of FP/ GPs regarding assessment and management of TIA.

The questionnaire included 4 sections; section one contained data regarding some demographic variables (gender, year of graduation, site of practice, practice duration in PHCCs, work load, having post- graduate Certification). The second section contained questions to assess Knowledge of the studied physicians regarding symptoms of TIA. The third section contained questions for assessing Knowledge of the studied physicians towards causes and risk factors of TIA. Also, it included questions regarding practicing screening for TIA in daily practice. The fourth section contained questions to assess practices of studied physicians regarding requesting diagnostic tests and treatment of TIA.

The questionnaire was reviewed by authors and staff of Family Medicine Department, Faculty of Medicine, Suez Canal University (FMD/FOM/SCU) to ensure that the questions were appropriate and would maximize response rates. A pilot study was conducted on 14 primary health care physicians aiming at testing validity of questionnaire. All the studied physicians (130) were subjected to structured interview but only 101 physicians were accepted to participate and completed the study. There were some missed data in 6 questionnaires, so, the total number was 95.

The obtained data were coded, entered and processed on a personal computer using Statistical Package of Social Science (SPSS) version 10. The appropriate statistical tests were used to identify significant difference. Chi square test was used for categorical data. A logistic regression analysis was used to test association of doing screening in daily practice with the studied variables. Statistical significance was considered at p-value < 0.05.

 

RESULTS

 

In the current study, out of the total studied physicians, 95 PHCPs completed the study and responded to properly. The response rate was 73.1% among those invited to participate (130 PHCPs). The majority of the studied physicians (53.7%) were female. Most of physicians in this study (68%) were graduated between the years of 2006 –2010 and 41.4% of them had got postgraduate certifications. More than sixty percent (61.1%) of studied physicians were working in a rural community. A considerable proportion of physicians in this study (56.8%) had practical experience ranged from 1-5  years in primary health care, with only 7.4 % were working for more than 10 years. About fifty percent of them (47.4 %) have got specialty in family medicine. The work load of majority of the respondents (69.5%) was in average rate 200-500 patients per month.

Table (1) shows knowledge of PHCPs about symptoms that enabling them to diagnose TIA correctly. It is evident that, majority of PHCS identified correctly most of symptoms consistent with TIA. On the other hand about one third of the studied physicians mentioned symptoms not consistent with TIA as isolated hand numbness (37.9%) and isolated vertigo (36.8%).

Table (2) shows the appropriate (correct) knowledge related to the duration of symptoms of TIA; only one fifth (21%) of studied physicians correctly identified duration of symptoms of TIA according to the recent definition (resolution of symptoms within 1 hour).  On the other hand, about half of them (42%) defined the duration according to old knowledge (resolution of any of these symptoms within 24 hours). More than one third of them (37%) were not knowledgeable (incorrect knowledge) regarding duration of resolution of symptoms of TIA.  

Most of the studied physicians were knowledgeable regarding causes /risk factors as shown in Figure (1). It is evident that, unhealthy life style, uncontrolled hypertension, dyslipidemia, diabetes mellitus and atrial fibrillation were mentioned by 92.6%, 87.4 %, 74.7%, 65.3% and 46.3% of physicians respectively.

Table (3) shows Knowledge of the studied physicians regarding diagnostic tests requested for TIA patients (regardless being in emergency or with history of recurrent TIA).  It is evident that head Computerized Tomography (CT), Magnetic Resonance Imaging (MRI),Carotid Duplex and hyper-coagulability work up(as appropriate diagnostic tests to start with) were mentioned by 63.2 %, 41.1%,32.6%, 20 % of the studied physicians respectively. On the other, 24.2% of them mentioned MR Angiography as diagnostic test to start with and another one quarter (24.2%) of studied physicians was not knowledgeable about which diagnostic test to start with.   

Regarding practices of PHCPs the screening of TIA in their practice, It was surprising to find only 43.2% of them were doing screening of TIA (either mostly [5.3%] or sometimes [37.9%]) as shown in Figure (2).

Table (4) shows practices of the studied physicians regarding appropriate action with TIA patient in emergency. It is found that, if they confronted with TIA patients, only one third of them (33.7%) decided to refer such patient to hospital for admission. Control of risk factors, starting anti-platelets and anti-coagulants were practiced by 20%, 31.6%, and 28.4% respectively.

Table (5) shows practices of the studied physicians regarding appropriate action regarding patient with history of TIA. It is found that, if they confronted with TIA patients, about fifty percent (48.4%) decided to control risk factors for such patient. Starting prescribing anti-platelets treatment and anti-coagulants were practiced by 27.4%, 12.6%. About one quarter (27.4%) of them decided to refer such patient for hospital for admission. On the other hand, only 14.7% evaluated patient for causes or mechanism of TIA.

Table (6) shows practices of the studied physicians regarding prescribing preventive treatment for patients with recurrent TIA. Prescribing anti-platelets was practiced by 56.8% of the studied physicians comparable with 22.1% for anticoagulants. More than one quarters of them prescribed inappropriate treatment (brain stimulants/anti-oxidants). Only 2.1% did not prescribe any treatment to such patients.  

Regarding referral to Neurologist on diagnosis or treatment of TIA patient, It is evident that more than three quarters (86.3%) referred such patient to neurologist (either mostly [57.9%] or sometimes [28.4%]). On contrary, 13.7% of the studied physicians did not refer such patient to neurologist.

Table (7) shows logistic regression to detect the most predictors of practicing screening for TIA among primary healthcare physicians. The model contained seven independent variables (gender, site of practice, years of practice, being certified, specialty, graduation year and average number of patient per month. However, the most contributing variables were physicians’ graduation year (those graduated ≥ 2000 were 2.42 more likely to practice TIA-screening); average number of patients per month (those who are consulting ≤ 500 patients per month were 1.69 times more likely to practice TIA-screening); and specialty (family physicians were 1.62 times more likely to practice TIA-screening than physicians with other specialties). Practicing in urban family practice and being female/certified physician were 1.31 and 1.37/1.20 times more likely to practice TIA screening respectively.


 

 

Table 1. Knowledge of the studied physicians regarding symptoms of Transient Ischemic Attack (TIA).

 

Symptoms suggestive of TIA

Total  (95)

Number

%

Symptoms consistent with TIA

§     Sudden difficulty walking, dizziness or loss of balance

§     Sudden numbness or weakness on one side of the body

§     Sudden difficulty speaking 

§     Sudden loss of vision in one or both eyes

Symptoms inconsistent with TIA

§     Isolated hand numbness

§     Isolated vertigo

 

78

71

55

44

 

36

35

 

82.1

74.7

57.9

46.3

 

37.9

36.8

 

 

Table 2. Knowledge of the studied physicians regarding duration of the symptoms of Transient Ischemic Attack (TIA). 

 

Duration of symptoms of TIA

Total  (95)

Number

%

Resolution of any of these symptoms within 1 hour (recently defined)  

Resolution of any of these symptoms within 24 hours  (old one)

Resolution of any of these symptoms within 25-48hours  (Incorrect )

Resolution of any of these symptoms within 1 week (Incorrect)

20

40

20

15

21

42

21

16

 

 

 

 

Figure 1. Knowledge of the studied physicians regarding causes and risk factors of TIA.

 

 

Table 3. Knowledge of the studied physicians regarding diagnostic tests requested for TIA patients (regardless emergency/ with Hx of TIA).

 

Diagnostic tests requested for TIA patient

Total (95)

Number

%

Appropriate tests to start with

1-  MRI

2-  Head CT

3-  Carotid Duplex

4-  Hyper-coagulability work up

5-  Trans-cranial Doppler

Inappropriate tests to start with

6-  Trans-thoracic echocardiogram

7-  MRA (MR Angiography)

8-  Trans-esophageal echocardiogram

No tests needed

Don’t Know

 

39

60

31

19

16

 

13

23

7

1

23

 

41.1

63.2

32.6

20.0

16.8

 

13.7

24.2

7.4

1.1

24.2

 

 

 

 

Figure 2. Distribution of the studied physicians regarding practices of screening for TIA among practice population.

 

 

Table 4. Practices of the studied physicians regarding appropriate action with TIA patient in Emergency.  

 

Appropriate action with TIA patient in Emergency

Total (95)

Number

%

1. Referral of patient for admission

2. Control risk factors

3. Start anti-platelet treatment

4. Start anti-coagulant treatment

5. Evaluate for cause or mechanism of TIA

32

19

30

27

6

3.7

20.0

31.6

28.4

6.3

 

   

Table 5. Practices of the studied physicians regarding appropriate action regarding patient with history of TIA.

 

Appropriate action for patient with  history of TIA

Total (95)

Number

%

1. Control risk factors

2. Start anti-platelet treatment

3. Start anti-coagulant treatment

4. Referral of patient for admission

5. Evaluate for cause or mechanism of TIA

46

26

12

26

14

48.4

27.4

12.6

27.4

14.7

 

 

Table 6. Practices of the studied physicians regarding prescribing preventive treatment for patients with recurrent TIA.

 

Preventive Treatment

Total ( 95 )

Number

%

§ Prescribed anti-platelet treatment (appropriate practice)

§ Prescribed anti-coagulant treatment (appropriate practice)

§ Prescribed brain stimulants/anti-oxidants (inappropriate practice)

§   No treatment is prescribed (inappropriate practice)

54

21

25

2

56.8

22.1

26.3

2.1

Table 7. Logistic regression analysis of the predictor variables for practicing TIA screening among studied physicians (N=95).

 

Predictors

Coef.

S.E

P-value

OR

95%CI

§ Gender (female)

0.31

0.45

0.487

1.37

0.57 – 3.32

§ Site of Practice (Urban)

0.27

0.45

0.551

1.31

0.54 – 3.15

§ Years of practice (≤ 10 years)

0.23

1.36

0.868

1.25

0.09 – 17.87

§ Certification (certified)

0.18

0.46

0.698

1.20

0.48 – 2.95

§ Specialty (family physician)

0.48

0.46

0.299

1.62

0.65 – 3.99

§ Graduation year (≥ 2000)

0.89

1.41

0.529

2.42

0.15 – 38.12

§ Average Number of patients per month (≤ 500)

0.52

0.65

0.423

1.69

0.47 – 6.09

§ Constant

- 2.24

1.57

0.154

0.11

 

 

 


DISCUSSION

 

The current study might be the first Egyptian study to determine level of knowledge and practices of primary health care physicians about TIA. It provides unique data reflecting the care of patients with first-ever TIA who are initially evaluated as outpatients by primary care physicians. More than half of the studied physicians (53.7%) were females. whilst internationally 62 % of GPs are males12. 

It is found that approximately 80% of primary health care physicians correctly recognize symptoms that consistent with TIA especially sudden difficulty walking, dizziness or loss of balance. On the other hand about 35% perceived isolated vertigo and hand numbness as symptoms of TIA while these symptoms are inconsistent with TIA. Diagnosis of TIA is challenging diagnostic process. This issue was raised and emphasized by Kraaijeveld et al. where they addressed that the diagnosis of TIAs has been reported among neurologist to be poor13.

Only 21% of the studied physicians correctly identified duration of symptoms of TIA according to the recent definition (resolution of symptoms within 1 hour). On the other hand 42% defined the duration according to old knowledge (resolution of any of symptoms within 24 hours). About 37% were not knowledgeable (incorrect knowledge) regarding duration of resolution of TIA symptoms. These results were in partial agreement with the reported results from several studies denoting that duration of TIA is a brief and less than 1hour14-16. Defining TIA with a 24-hour maximum duration has the potential to delay the initiation of effective stroke therapies. Such therapeutic strategy is consistent with Evidence Based Medicine (EBM)16.

Most of the studied primary health care physicians were found to be well informed about the risk factors especially unhealthy life style and hypertension. Unfortunately they were less knowledgeable about atrial fibrillation (AF) as a risk factor for TIA, as only 46% of them recognized it as a TIA risk factor.

Only 60% of the studied physicians in the current study mentioned they will arrange for brain CT, 40% arrange for brain MRI, 32% for Carotid/vertebral ultrasound, 16.8% for Trans-cranial Doppler and 20% for hyper-coagulability state tests for symptomatic or patients with history of TIA. Results from UK study mentioned that, 24% of GPs would not arrange any investigations for patients after a recent TIA or minor ischemic stroke17.

Clinical Guidelines for TIA and Acute Stroke Management was developed by The National Stroke Foundation in 200716. Such recommendations denoted that; Patients with TIA should preferably undergo neuro-imaging evaluation within 24 hours of symptom onset. MRI, including DWI, is the preferred brain diagnostic imaging modality. If MRI is not available, head CT should be performed (Class I, Level of Evidence B). Noninvasive imaging of the cervicocephalic vessels should be performed routinely as part of the evaluation of patients with suspected TIAs (Class I, Level of Evidence A). Noninvasive testing of the intracranial vasculature reliably excludes the presence of intracranial stenosis (Class I, Level of Evidence A).Patients with suspected TIA should be evaluated as soon as possible after an event (Class I, Level of Evidence B)16.

The reason(s) for the unexpectedly infrequent use of vascular imaging studies is uncertain. Low awareness and cost-effectiveness data are generally lacking, and might explain why neuroimaging studies were underused in this group of patients as emphasized by some authors18.

Regarding practicing of TIA screening in daily work, it was surprising to find only 43.2% of PHCPs were doing screening of TIA (either mostly [5.3%] or sometimes [37.9%]) among their patients. Females, physicians in urban areas, certified, family physicians, physicians of less than 10 years of practice and with work load of less than 500 patients per month found to screen for TIA among their patients more frequently. However, with continued workforce shortages in primary care and limited consultation time, Primary health care physicians are facing time pressures in providing comprehensive care to the patients including screening for TIA.

Timely referral of TIA patients is a crucial in management process. Only, 34% of the studied PHCPs in the present study referred their patients with current TIA to the hospital. Close observation during hospitalization has the potential to allow more rapid and frequent administration of tissue plasminogen activator if a stroke occurs. It is reasonable to hospitalize patients with TIA if they present within 72 hours of the event according to evidence based guidelines Class IIa, Level of Evidence C)16.  The low proportion of referring patients to the emergency department indicates a lack of awareness of the studied physicians that a TIA is a medical emergency. However, about 50% of PHCPs in our study choose to control risk factors first if the patient has a history of TIA.

Prescribing preventive treatment for patients with recurrent TIA is a crucial in daily practice of PHCPs.  In our study, they appear to be well informed and practicing for the use of anti-platelet and anti-coagulant as preventive treatment in patients with TIA as 56.8% prescribed anti-platelet treatment and 22.1% prescribed anti-coagulant treatment. These results were in agreement with those of Goldstein et al who stated that, the primary care physicians added a platelet antiaggregant, changed the dose of the current platelet antiaggregant, or prescribed a new platelet antiaggregant in nearly half of the patients with TIA19.

Coordination of care to TIA patients is a pre-requisite if we are aiming at achieving a favorable outcome. This could be done by indicative referral (either urgent or elective) to the concerned specialty. In our study, 57.9% of PHCPs are referring TIA patients to neurologist mostly and 28.4% referring them sometimes. This high percent of referral also can explain the low percentage of neuroimaging requested by GPs as they may leave this mission to the neurologist. Such a high referral rate might be explained in the view of the existing health system in which a considerable proportion of TIA patients are not insured and cannot pay for the requested investigations.

In Conclusion; knowledge of primary health care physicians regarding TIA was unsatisfactory. Regarding practices of the studied physicians were not far beyond that of knowledge where the majority of primary health care physicians achieved fair/poor practice. With training and introducing appropriate knowledge and recent guidelines of TIA to all PHCPs, this could enhance better performance in assessment and management of TIA effectively in the community.
Study limitation
In the current study the ability to attribute causality and to extrapolate the findings in this study is limited by the cross-sectional study design and the small sample size. The current study is considered to be limited also because it was done in Ismailia governorate which includes small number of physicians compared to other regions in Egypt.

 

Acknowledgment

The authors would like to thank all participants in the study, directors, and staff members of family practice centers/units affiliated to MOHP for their assistance in conducting the study.

 

[Disclosure: Authors report no conflict of interest]

 

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2.        Price TR, Psaty B, O'Leary D, Burke G, Gardin J. Assessment of cerebrovascular disease in the Cardiovascular Health Study. Ann Epidemiol. 1993; 3: 504-7.

3.        Toole JF, Chambless LE, Heiss G, Tyroler HA, Paton CC. Prevalence of stroke and transient ischemic attacks in the Atherosclerosis Risk in Communities (ARIC) study. Ann Epidemiol. 1993; 3: 500-3.

4.        Dennis M, Bamford J, Sandercock P, Warlow C. Prognosis of transient ischemic attacks in the Oxfordshire Community Stroke Project. Stroke. 1990; 21: 848-53.

5.        Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988; 19: 1083-92.

6.        Coull AJ, Lovett JK, Rothwell PM. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: Implications for public education and organisation of services. BMJ. 2004; 328: 326-8.

7.        Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000; 284: 2901-6.

8.        Lavallee PC, Meseguer E, Abboud H, Cabrejo L, Olivot JM, Simon O, et al. A Transient Ischaemic Attack Clinic with Round-the-Clock Access (SOS-TIA): Feasibility and effects. Lancet Neurol. 2007; 6: 953-60.

9.        Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, et al. Effect of Urgent Treatment of Transient Ischaemic Attack and Minor Stroke on Early Recurrent Stroke (EXPRESS Study): A prospective population-based sequential comparison. Lancet. 2007; 370: 1432-42.

10.     Johnston S, Rothwell P, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007; 369: 283-92.

11.     Middleton S, Sharpe D, Harris J, Corbett A, Lusby R, Ward J. Case scenarios to assess Australian general practitioners' understanding of stroke diagnosis, management, and prevention. Stroke. 2003; 34: 2681-7.

12.     Hordacre AL, Howard S, Moretti C, Kalucy E. Making a difference. Report of the 2005–2006 annual survey of divisions of general practice. Adelaide: Primary Health Care Research & Information Service; 2007 Jul. p. 152.

13.     Kraaijeveld CL, van Gijn J, Schouten HJA, Staal A. Interobserver agreement for the diagnosis of transient ischemic attacks. Stroke 1984; 15(4): 723-5.

14.     Levy DE. How transient are transient ischemic attacks? Neurology. 1988; 38: 674-7.

15.     Weisberg LA. Clinical characteristics of transient ischemic attacks in black patients. Neurology. 1991; 41: 1410-14.

16.     Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007; 38: 1655-711.

17.     Mead GE, Murray H, McCollum CN, O’Neill PA. How do general practitioners manage patients at risk from stroke? Br J Clin Pract 1996; 50: 426-30.

18.     Goldstein LB, Bian J, Samsa GP, Bonito AJ, Lux LJ, Matchar DB. New transient ischemic attack and stroke: outpatient management by primary care physicians. Arch Intern Med. 2000; 160(19):2941-6.

19.     Goldstein LB, Bonito AJ, Matchar DB, Duncan PW, Samsa GP. US National Survey of Physician Practices for the Secondary and Tertiary Prevention of Ischemic Stroke: carotid endarterectomy. Stroke. 1996; 27: 801-6.


 

 

الملخص العربى

 

دراسة معارف وممارسات أطباء الرعاية الصحية الأولية تجاه نوبات قصور الدورة الدموية المخية العابرة

بالأسماعيليه - مصر

 

يحتاج مرضى نوبات قصور الدورة الدموية المخية العابرة ضرورة التقييم والعلاج المبكر. معظم هؤلاء المرضى يكون أول اتصال لهم بشكل متكرر هو طبيب العائلة /الممارس العام بدلا من البحث عن الرعاية الصحية فى المستشفى وذلك لأن الأعراض تكون بسيطة.

هذه الدراسة تهدف الى تقييم المعارف والممارسات لأطباء الرعاية الصحية الأولية بمحافظة الإسماعيلية فيما يتعلق بنوبات قصور الدورة الدموية المخية العابرة. الدراسة الحالية أجريت على كل أطباء الرعاية الصحية الأولية العاملين فى جميع وحدات ومراكز الرعاية الصحية الأولية فى محافظة الإسماعيلية والبالغ عددهم (130) وقد تم دعوتهم للمشاركة فى الدراسة وقد أكمل الدراسة منهم 101 طبيب وكان معدل الاستجابة 73.1% بين الأطباء المدعوين للمشاركة. هناك بعض البيانات الغير مكتملة فى استمارة الاستبيان لستة أطباء ومن ثم تم استبعادهم  ليكون العدد الكلى 95 طبيب. تم تقييم معارفهم وممارساتهم فيما يتعلق بنوبات قصور الدورة الدموية المخية العابرة باستخدام استمارة استبيان مصممة لهذا الغرض.

معظم الأطباء حددوا بشكل صحيح معظم الأعراض التى تتفق مع نوبات قصور الدورة الدموية المخية العابرة. ومن ناحية أخرى نحو ثلث الأطباء ذكروا أعراض لا تتفق مع أعراض نوبات قصور الدورة الدموية المخية العابرة. وجدت الدراسة أيضا أن خمس الأطباء فقط حددت بشكل صحيح مدة النوبات وفقا للتعريف الحديث (1 ساعة). كان ربع الأطباء ليسوا على دراية بالاختبار التشخيصي الذي يمكن أن يبدأ به العلاج. وقد أظهرت ممارسات الأطباء أن 43.2٪ فقط قاموا بإجراء المسح لاكتشاف تاريخ مرضى سابق من تلك النوبات لدى المرضى المترددين على مراكز الرعاية الصحية الأولية بينما قرر ثلث الأطباء أن يحولوا المرضى المصابين بنوبة حالية إلى المستشفى. كما أظهرت الدراسة أن 48.4٪  منهم قاموا بالتحكم في عوامل الخطورة للمرضى الذين لديهم تاريخ سابق من تلك النوبات.  وكذا أظهرت الدراسة أن أكثر من ربع الأطباء قاموا بوصف العلاج الغير مناسب للمرضى فى حين أن 2.1٪ لم يقوموا بصرف أى علاج.

هذا وخلصت الدراسة الى أن المعارف والممارسات لدى أطباء الرعاية الصحية الأولية بمحافظة الإسماعيلية فيما يتعلق بنوبات قصور الدورة الدموية المخية العابرة غير مرضية ويوصى بعقد دورات تدريبية منتظمة لهؤلاء الأطباء.



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