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Does higher quality primary health care reduce stroke admissions?


Hospital admission rates for stroke are strongly associated with population factors. The supply and quality of primary care services may also affect admission rates, but there is little previous research on this association. In a paper published recently in the British Journal of General Practice, Michael Soljak and colleagues from the Department of Primary Care & Public Health at Imperial College London investigated whether the hospital admission rate for stroke is reduced by effective primary and secondary prevention in primary care.

This was a national cross-sectional study in an English population (52 763 586 patients registered with 7969 general practices in 152 primary care trusts). They found that mean annual stroke admission rates per 100 000 population varied from zero to 476.5 at practice level. In a practice-level multivariable Poisson regression, observed stroke prevalence, deprivation, and smoking prevalence were all risk factors for hospital admission. Protective healthcare factors included the percentage of stroke or transient ischaemic attack patients whose last measured total cholesterol was ≤5 mmol/l, and ability to book an appointment with a GP.

They concluded that the associations of stroke admission rates with deprivation and smoking highlight the need for effective smoking-cessation services. Patient experience of access to primary care may also be clinically important. In countries with well-developed primary healthcare systems, the potential to reduce hospital admissions by further improving the clinical quality of primary healthcare may be limited unless more rigorous quality improvement measures than those currently being used are implemented.

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