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From the Departments of Neurology (Drs. Holloway and Benesch) and Community and Preventive Medicine (Dr. Holloway), University of Rochester School of Medicine and Dentistry, Rochester, NY; and Quality Improvement (S.R. Rush), American Academy of Neurology, St. Paul, MN.
Address correspondence and reprint requests to Dr. Holloway, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642.
Many interventions reduce stroke risk. However, the full benefits of these interventions are not realized at current levels of utilization, as nearly all evidence-based or guideline-endorsed stroke prevention services are underused. The cause for such underuse is multifactorial and includes factors relating to both patients and providers, as well as to a health care system that has de-emphasized prevention at the expense of acute, technologically based care. Much like the evidence for stroke interventions themselves, there is a growing literature to support methods of implementing research evidence into clinical practice. There is still much to learn, however, about the effectiveness of interventions aimed at achieving changes in stroke prevention practice or the delivery of stroke prevention care. Nevertheless, there are many opportunities for providers, managed care organizations, and government to close the evidence–practice gap that exists for stroke prevention services. These opportunities exist in both the inpatient and outpatient setting, and depend on the neurologist taking a leading role in emphasizing the critical importance of risk factor identification and modification in all patients at risk for stroke.
Key words: Stroke—Prevention—Risk factors—Health services.
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