Changes in the provision of transient ischaemic attack services in New Zealand 2008 to 2013

Abstract

BACKGROUND: Urgent assessment and management of patients with transient ischaemic attack (TIA) reduces the early risk of stroke. In 2008 an audit was conducted of TIA services in New Zealand and a substantial discrepancy was found between clinical practice and recommendations in TIA guidelines. We aimed to re-evaluate the situation again in 2013 to determine if there had been any change in provision of TIA services. METHODS: A brief written questionnaire, based on the 2008 survey, was sent to lead stroke clinicians at all district health boards. Questions were asked about the provision of services, including investigation and management of patients with TIA. RESULTS: The questionnaire was completed by all DHBs. The number of DHBs with a dedicated TIA clinic has increased from 3 in 2008 to 15 in 2013 and the number with a clinical pathway for assessment of patients with TIA has increased from 5 to 17. Brain and carotid imaging is usually available within 48h for patients assessed as having high stroke risk. Delays for other patients remain frequent for brain imaging in 14 DHBs and for carotid imaging in 16 DHBs. There was a decrease in the number of DHBs with a wait of more than a week for carotid endarterectomy when indicated from 16 in 2008 to 4 in 2013. CONCLUSION: There have been significant improvements in the provision of TIA services over the last 5 years. However in order to reduce the burden of stroke, DHBs need to consider further investments into adequately resourced TIA services as a priority.