Our Evidence

TIA Stroke | Paediatric Asthma |

TIA Stroke

  • The TIA stroke module was evaluated within the FASTEST trial (Efficacy and Safety of a TIA Electronic Support Tool) - Accepted for publication in Neurology.

  • Hypothesis
    • TIA/Stroke Risk Assessment Module
    • The implementation of the primary care based TIA/stroke electronic decisions support tool can improve TIA guideline adherence and reduce the risk of early recurrent stroke without compromising patient safety

  • Evaluation
    • Multi-centre, single-blind, parallel, cluster randomized controlled trial (1:1) in NZ comparing management by practices that received targeted disease area training, the Integrated Clinical Consultation Support (ICCS) tool or both compared to no intervention. GP initial diagnosis of TIA or stroke (all included in analysis regardless of ultimate adjudication).

  • Outcomes
    • 40% increase in accuracy of diagnosis of TIA compared to control (data not shown)
    • Clinically important and statistically significant reductions in any vascular event and death at 90 days (figure).
    • Improved adherence to best practice guidelines. Improved counseling.
    • Optimal outcome came from the use of the ICCS tool by GPs and Nurses who had received focused training.
    • No increase of adverse safety events.
    • Significant cost savings (NZ$1,479 per patient).

Reviews each patient record at the start of each consultation, undertakes risk assessments such as cancer risk assessments and identifies whether a patient should be considered for particular assessments, a clinical module or a clinical referral pathway.

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Extensive range of clinical consultation support modules based on NICE adapted to local requirements for patients who have one or more clinical condition.

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Extensive range of referral pathways that are based on local standards for patient referral management.

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Paediatric Asthma

In April 2009, the bestpractice Decision Support Childhood Asthma module was released to all general practitioners in New Zealand. As of November 2010, 3,331 general practitioners have access to the module.

The evaluation of the programme focused on the key data indicators of hospitalisations for asthma related diagnoses for children under 15 who were assessed with the bestpractice module, which was based on child-years at risk*.

The results of the evaluation showed that children with asthma who were managed with the bestpractice module were significantly less likely to be hospitalised with an asthma related diagnosis following their assessment with the bestpractice module than they were before (p=0.01)

New Zealand

Paediatric asthma pathway introduced based on NICE guidelines.

Hospitalisations per 100 child-years for the cohort of children managed within the Valida Decision Support module before implementation and after.