TIA models of care in Melbourne and Geelong - A contemporary survey.

Abstract

Background: An objective of the National Strategic Action Plan for Heart Disease and Stroke 2021 is to improve access to transient ischaemic attack (TIA) clinics. It is unclear how patients with TIAs are managed by public health services in the two largest cities in Victoria. Aim(s): To review models of care for managing TIAs in health services with neurology departments in Melbourne and Geelong. Method(s): Neurologists from ten health services took part in a survey by telephone or video conference. The survey consisted of 39 questions focusing on TIA management. Result(s): The estimated volume of TIA presentations ranged from 13 to 39 per month. The neurology department's involvement in the ED presentation varied; two services aimed to physically review every patient, six aimed to provide at least phone advice to all, and two encouraged ED staff to call if concerned. Two services rarely admitted TIA patients (<10%), one admitted all TIA patients overnight, and the remaining seven varied, admitting on average 22% of TIAs. Six preferred CT angiography for initial vessel imaging, and four preferred Doppler ultrasound. All services ensured an antithrombotic was prescribed. Five services routinely prescribed a statin, and three regularly prescribed antihypertensives. Five services routinely ordered outpatient cardiac investigations from ED, and six routinely ordered outpatient MRI from ED. The average wait for MRI varied from next day to multiple months. Two had dedicated TIA clinics running every weekday if required, and eight had dedicated or mixed clinics running at least weekly. The average wait for these clinics varied from under a week to 3-6 months. Conclusion(s): There is heterogeneity in models of care for managing patients with TIA. There are opportunities to benchmark a quality standard, and improve access to TIA clinics and investigations, so patients receive the same standard of care irrespective of their postcodes.