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Integrated care improves risk factor modification one year after stroke: initial results of the ICARUSS model
  1. Jacques Joubert (jacquesjoubert{at}bigpond.com)
  1. Royal Melbourne Hospital, Australia
    1. Chris Reid
    1. Monash University, Australia
      1. David Barton
      1. Royal Melbourne Hospital, Australia
        1. Toby Cumming
        1. NARI, Parkville, Australia
          1. Allan McLean
          1. NARI, Parkville, Australia
            1. Lynette Joubert
            1. University of Melbourne, Australia
              1. John Barlow
              1. NARI, Parkville, Australia
                1. David Ames
                1. NARI, Parkville, Australia
                  1. Stephen Davis
                  1. Royal Melbourne Hospital, Australia

                    Abstract

                    Objective: Despite evidence demonstrating that risk factor management is effective in reducing recurrent cerebrovascular disease, there are very few structured care programs for stroke survivors. Our aim was to implement and evaluate an integrated care program in stroke.

                    Methods: 186 stroke patients were randomised to either the treatment (integrated care) or control (usual care) group and were followed up over 12 months. The ICARUSS model of integrated care involved collaboration between a specialist stroke service, a hospital coordinator, and a patient’s general practitioner. The primary aim was to promote the management of vascular risk factors through ongoing patient contact and education.

                    Results: In the 12 months post stroke, systolic blood pressure (sBP) dropped in the treatment group but increased in controls. The group difference was significant, and remained so when age, sex, disability and sBP at discharge were accounted for (p=0.04). Treatment patients also exhibited better modification of body mass index (p=0.007) and number of walks taken (p<0.001) than controls. Rankin scores indicated significantly reduced disability in treatment patients relative to controls in the year post stroke (p=0.003).

                    Conclusions: Through an integrated system of education, advice and support to both patient and GP, the ICARUSS model was effective in modifying a variety of vascular risk factors and therefore should decrease the likelihood or recurrent stroke or vascular event.

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