Beliefs regarding the effectiveness of stroke prevention practices: differences among provider specialties

Johnston DCC, Oddone EZ, Horner RD, Stechuchak K. Beliefs regarding the effectiveness of stroke prevention practices: differences among provider specialties. Journal of clinical outcomes management : JCOM. 2002 Dec 1; 9(12):667-675.

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Abstract:

Objective: To determine whether providers with different specialty training differ in their perception of the effectiveness of common diagnostic and therapeutic practices for stroke prevention. Design: Cross-sectional survey. Setting: 5 Veterans Affairs medical centers. Participants: Physicians and mid-level providers caring for patients who had received a carotid ultrasonography evaluation. Measurements: Participants completed a questionnaire with 3 typical patient scenarios (patients older than 65 years with no symptoms, with a transient ischemic attack, and with stroke) that asked them to rate the effectiveness of common diagnostic procedures and therapeutic interventions for stroke prevention in each scenario. Results: The sample of 183 providers included general internists (n = 80), neurologists (n = 16), vascular surgeons (n = 20), other medical and surgical specialists (n = 28), and mid-level providers (n = 39). There were wide variations in the perception of the effectiveness of procedures according to specialty. For example, 65% of surgeons rated angiography as effective for asymptomatic patients compared to 11% of mid-level providers (P < 0.001), and surgeons reported significantly greater effectiveness of carotid endarterectomy than other providers (P = 0.02). Conclusions: Important differences in assumptions about the effectiveness of common stroke prevention strategies were found among providers caring for patients at risk for stroke. These findings highlight the importance of ongoing provider education regarding best practices for stroke prevention. Educational efforts should be directed at those providers who commonly see patients at risk for stroke, regardless of their training background