Delay in accessing healthcare after transient ischaemic attack and minor stroke : the role of primary care in the problem and the solution

Abstract

Transient ischaemic attack (TIA) and minor stroke are associated with a high risk of recurrent stroke which can be predicted with a clinical rule and reduced with urgent treatment. Delay in accessing assessment and vascular risk factor modification should therefore be as short as possible, yet little is known in the UK about where patients seek care and the key influences of the time to contact healthcare services. However, using cohort studies to answer questions on healthcare access requires an assessment of how well such cohorts represent the wider population. Within the primary care consultation, the recognition of TIA is an important step in the care pathway as definitive treatment is initiated by specialists, yet TIA presentations are not common for individual GPs and difficulties in diagnosis may be due to low clinical exposure in routine practice or inadequacies in training. For patients where GPs suspect that TIA may be the cause of symptoms, inaccurate risk prediction and diagnosis of TIA can result in delay to definitive care and the existing tools for prognosis and diagnosis have been exclusively derived from clinical assessments in secondary care rather than primary care.