Improving Primary Care Provider Knowledge of Recurrent Ischemic Stroke Prevention Guidelines

Abstract

Purpose: The purpose of this quality improvement project was to improve primary care provider (PCP) knowledge and intention to employ evidence-based guidelines for recurrent ischemic stroke (IS) prevention following a brief educational session reviewing a one-page checklist tool created by the Project Manager (PM) which addresses four major risk factors—diabetes, hypertension (HTN), hyperlipidemia, and nonvalvular atrial fibrillation (AFIB). Background: IS causes millions of deaths annually, resulting in substantial economic costs and reduced physiological and psychological function. Many patients are seen in the primary care setting where risk factors for recurrent IS should be addressed soon after hospital discharge. The American Heart Association (AHA) and the American Stroke Association (ASA) have identified nonvalvular AFIB, HTN, hyperlipidemia, and diabetes as major risk factors for recurrent IS. Important management includes blood pressure, lipid, and blood glucose parameters in addition to pharmacological management. In a busy primary care environment, providers should refer to an efficient and informative tool addressing these risk factors. Methods: The framework for this project was Lewin’s Three-Step Model of Change while the Plan-Do-Study-Act (PDSA) Cycle was the implementation model. Pre- and post-surveys were developed to assess PCP knowledge before and after an educational session on using a checklist tool. A one-page laminated checklist tool was created, highlighting the management of nonvalvular AFIB, HTN, hyperlipidemia, and diabetes. The project was conducted at a primary care facility in Oro Valley, Arizona with three PCPs. Results: Following the educational session reviewing the checklist tool, 100% of provider participants strongly agreed they were knowledgeable about prevention guidelines for the selected risk factors. In addition, 100% of provider participants indicated the tool would be feasible for daily practice and would value accessing the checklist through the electronic health record (EHR). Each provider received a copy of the checklist for their professional use. Conclusions: A one-page checklist tool on recurrent IS prevention guidelines is an effective intervention to improve knowledge and intention to employ evidence-based guidelines. As such, PCPs demonstrated increased IS risk factor knowledge and indicated intention to adopt this tool in practice.