A Program to Improve Use of Antithrombotic Medicines and Reduce the Incidence of Stroke

This chapter describes a historical program to improve management of patients at risk of stroke. While guidelines for management of stroke have changed since the time of this program, the value of this piece of work lies in the detail provided on the methods and utilisation of formative research, program design and program evaluation. Of particular note, is the evaluation of the impact of the program on health outcomes at a population level, which is the ultimate goal of many programs and yet one that we cannot always measure. Stroke is a common health event, and it causes significant morbidity and mortality. Preventative management in high-risk individuals is known to reduce the likelihood of stroke, and yet primary care doctors only implement guidelines in about 60% of patients. This chapter describes a large multifaceted intervention to improve prescribing in patients at risk of stroke. It outlines the rationale for topic selection, the use of formative research to design key messages, as well as process and summative evaluations. This program was able to show changes in clinicians’ knowledge, changes in prescribing of clopidogrel and changes in hospitalisation due to stroke at a population level.