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Introduction During the past decade, out of hours services have been the object of attention in many countries. In Denmark more and more general practitioners became dissatisfied with the workload [...]

Introduction Only a minority of patients with acute ischaemic stroke receive reperfusion treatment, primarily due to prehospital delay. We aimed to investigate predictors of a primary contact to the emergency medical services, arrival at stroke centre within 3 h of symptom onset and initiation of reperfusion therapy in patients with acute stroke.Patients and methods We conducted a cross-sectional study of consecutive patients with acute ischaemic stroke, intracerebral haemorrhage or transient ischaemic attack. Structured interviews of patients and bystanders were performed and combined with clinical information from the Danish Stroke Registry. Eligible patients were aged ≥18 years and were independent in activities of daily living before the stroke.Results We included 435 patients. Presence of a bystander at symptom onset and knowledge of ≥2 core symptoms of stroke were associated with a primary emergency medical services contact. Higher stroke severity and patients or bystanders perceiving the situation as very serious were associated with a primary emergency medical services contact (ORpatients2.10; 95% CI 1.12–3.95 and ORbystanders22.60; 95% CI 4.98–102.67), <3 h from onset to arrival (ORpatients3.01; 95% CI 1.46–6.21 and ORbystanders4.44; 95% CI 1.37–14.39) and initiation of reperfusion therapy (ORpatients3.08; 95% CI 1.23–7.75 and ORbystanders4.70; 95% CI 1.14–19.5). Conclusion:Having a bystander, knowledge of ≥2 core symptoms and understanding that stroke is a serious event are associated with appropriate help-seeking behaviour, shorter prehospital delay and higher chance of reperfusion therapy in acute stroke patients.

24-Hour Primary Care Eds Chris Salisbury, Jeremy Dale, Lesley Hallam Radcliffe Medical, 19.95 £, pp 248 ISBN 1 85775 311 9 Rating: *** During the past few decades European general [...]

Background The need to optimize frequent attender (FA) care and to economize on scarce resources in primary care has given rise to calls for intervention. However, precise knowledge of the specifics of this need is scarce, as is knowledge of how best to orchestrate intervention vis‐à‐vis particular FA groups. The aim of the study was to analyse the need for a special FA status consultation and to analyse if such need springs from physical, mental or social factors among FAs.Method Half of the 270 general practices in the County of Aarhus, Denmark, were randomly allocated to the study group (in total 132 practices; 220 general practitioners (GPs)). From these practices age‐ and gender‐stratified samples of FAs were drawn. FAs were defined as the top 10 per cent attenders in 12 months. Questionnaires were used to elicit FA and GP attitudes to the introduction of a status consultation and to obtain GPs' evaluation of their FAs' physical, mental and social status. The special FA consultation was introduced as a reimbursed half‐hour consultation where the FA and the GP could discuss the patient's current and future care status.Results Over three‐quarters of the FAs would accept the offer to have the status consultation, and the GPs would recommend it for one‐fourth of their FAs. The expressed need was highly associated with an expected positive effect on health (prevalence ratio (PR) for GPs: 11.7 (8.9–15.5), PR for FAs: 1.6 (1.5–1.8)) and a decrease in attendance (PR for FAs: 1.4 (1.3–1.5)). The GPs quoted physical, mental and social indications for the consultation. The FAs who had high levels of functional symptoms were most likely to accept the consultation.Conclusions There was an expressed need for an FA status consultation, which may lead to a positive effect on health and attendance. The GPs pointed to physical, mental and social indicators for a special FA consultation.