Matters arising

Health services administration
Volume 197 - Issue 10

CareTrack: assessing the appropriateness of health care delivery in Australia

Authors:  Thanh G Phan and Velandai K Srikanth

Med J Aust 2012; 197 (10): 548. || doi: 10.5694/mja12.11187
Published online: 19 November 2012
To the Editor: We write to express our concerns with the article by Runciman and colleagues on the appropriateness of health care delivery in Australia.1 Our concerns focus on the issue of stroke care and the notion that poor compliance with guidelines is interpreted as “inappropriate” patient care. This study did not measure hard clinical end points, such as stroke recurrence, when evaluating the appropriateness of ...
Download PDF (414 KB)
Share: Share on Blue Sky Share on Facebook Share on LinkedIn Share by email

To the Editor: We write to express our concerns with the article by Runciman and colleagues on the appropriateness of health care delivery in Australia.1 Our concerns focus on the issue of stroke care and the notion that poor compliance with guidelines is interpreted as “inappropriate” patient care.

This study did not measure hard clinical end points, such as stroke recurrence, when evaluating the appropriateness of care delivery. The observed decline in hospitalisation and mortality rates for stroke in Australia must mean that “primary and secondary prevention strategies are working”.2 Our primary care physicians should be congratulated for these improvements in health outcomes, which surely result from “appropriate care”.

Runciman et al used the 2007 National Stroke Foundation guideline (which is now outdated), including the ABCD2 (age, blood pressure, clinical features, duration and diabetes) score for predicting risk of stroke after transient ischaemic attack (TIA). We admit that we are guilty of not using this score, yet we achieved a low 90-day stroke recurrence rate after TIA (2.42%).3 Does this mean that we have not delivered appropriate care?

The ABCD2 score predicts stroke risk poorly3,4 and may lead to patients with high-risk stroke mechanisms being inappropriately classified as low-risk. The use of the ABCD2 tool to triage admission could increase the admission rate from 19.6% to 71.1% in our centre.3 Therefore, could the use, rather than non-use, of this score potentially lead to medicolegal suit?5 Would this not be termed “inappropriate” use of a public resource?

Authors

  • Thanh G Phan1
  • Velandai K Srikanth1
  • 1. Monash Medical Centre, Monash University, Melbourne, VIC.

Correspondence: thanh.phan@monash.edu

Competing interests

Thanh Phan has received honoraria from Bayer and Genzyme for presenting lectures on stroke. He has been invited to attend a Genzyme-sponsored Fabry disease neurology board meeting in January 2013.

References

View this article on Wiley Online Library

More like this

View more