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In reply: The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit

Jonathan W Sturm, Stephen M Davis, John G O'Sullivan, Miriam E Vedadhaghi and Geoffrey A Donnan
MJA 2002 177 (7): 399

In reply: We thank Middleton et al for their interest in our article. As 96% of questionnaires in our ASAP study1 were completed by September 2000, their study (as yet unpublished) and ours were not concurrent. Statistically, based on the information given by Middleton et al, we would expect 5.5 GPs (296 x 333/18066) to be involved in both studies. Chance, or because direct involvement in the ASAP study had finished months earlier, may explain why none of the doctors in the survey by Middleton et al stated that they were involved in a stroke audit.

In answer to the claim that "no GP data by State and Territory" were provided, we did in fact indicate in our article how many GPs from each State and Territory participated.

Intracluster correlations (ICCs)2 for each risk factor in our study are shown in the Box. ICCs have a greater effect on sample size than on CIs, because CI width is inversely proportional to the square root of the sample size. The large sample size of ASAP means that the study has acceptable precision, even after allowing for ICCs.

Overall estimates for risk factors were provided for the population of people consulting GPs, which is the relevant population. We would not necessarily expect the same distribution of risk factors in people not attending GPs. Age- and sex-specific risk-factor prevalences, shown in Box 3 of our article,1 can be used to calculate age- and sex-standardised rates for any desired population.

We are confident that the information obtained in our study is likely to be representative of most Australian general practice environments.

Intracluster correlations (ICCs) for stroke risk factors in the ASAP stroke audit1*

Risk factor

All

Men

Women


Current smoker

0.07

0.09

0.08

Hyper-cholesterolaemia

0.06

0.06

0.07

Hypertension

0.06

0.05

0.07

Diabetes

0.04

0.05

0.07

Past TIA/stroke

0.018

0.024

0.013

Atrial fibrillation

0.016

0.017

0.023


TIA = transient ischaemic attack. * Calculated using the analysis of variance (ANOVA) method.2

  1. Sturm JW, Davis M, O'Sullivan JG, et al. The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit. Med J Aust 2002; 176: 312-316. <PubMed> <eMJA full text>
  2. Ridout MS, Demetrio CBG, Firth D. Estimating intraclass correlation for binary data. Biometrics 1999; 55: 137-148. <PubMed>

(Received 18 Jun 2002, accepted 20 Jun 2002)

National Stroke Research Institute and Department of Neurology, Austin and Repatriation Medical Centre, Heidelberg West, VIC.

Jonathan W Sturm, MB ChB FRACP, Research Fellow; Geoffrey A Donnan, MD FRACP, Director of NSRI; and Director of Neurology.

Department of Medicine, Melbourne University, and Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC.

Stephen M Davis, MD FRACP, Director of Neurology.

Blackburn Clinic, Blackburn, VIC.

John G O'Sullivan, MB BS FRACGP, Associate.

Servier Laboratories, Hawthorn, VIC.

Miriam E Vedadhaghi, BSc PostGradDipNutr&Diet, Project Associate.

Correspondence: Dr Jonathan W Sturm, National Stroke Research Institute and Department of Neurology, Austin and Repatriation Medical Centre, Level 1, Neurosciences Building, Banksia Street, Heidelberg West, VIC 3081 jsturmATaustin.unimelb.edu.au

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©The Medical Journal of Australia 2002 www.mja.com.au PRINT ISSN: 0025-729X ONLINE ISSN: 1326-5377