Background A TIA can offer a vital warning to the risk of a disabling or fatal stroke. Appropriate help seeking behaviour, followed by referral to TIA services allows diagnosis and treatment of conditions that are major risk factors for stroke such as hypertension, as well as opportunities to alter behavioural risk factors. The incidence, and prevalence of stroke and the risk of mortality following stroke is substantially higher in patients from lower socioeconomic groups. This study sought to explore access to TIA prevention services following a TIA, in order to understand the profile of patients both represented and underrepresented and also the patterns of referral that enable patients to access prevention services.
Methods Routine hospital data was collected and anonymised. Analysis was performed using Microsoft excel and SPSS software. Collected data included patient’s age, ethnic origin, sex and socioeconomic status as measured by Index of Multiple Deprivation. It also included source of referral and the time between referral and being seen in clinic.
Results Over the three years, 3069 patients attended TIA clinics, including patients who were later found to have alternative diagnosis but had suffered symptoms suggestive of a TIA. More women (n = 1613) were seen than men (n = 1456). Risk of stroke is higher in men, and this disparity is seen both nationally and locally. Our data suggests that men are not help seeking following symptoms of a TIA as responsively as women. The mean age of patients was 69.6 years. The majority were ‘British white’ (97%), only 3% described themselves as members of minority ethnic groups. The proportion of the population in Sheffield from ethnic minority groups is 7.2%. Again this would suggest that members of these groups are not responding to TIA symptoms and seeking help, enabling appropriate referral or alternatively not being appropriately referred after seeking help. Rates of referral from more deprived areas were also lower than projected figures would predict. The majority of referrals to secondary care following a TIA came from general practitioners (60%), suggesting that most patients do not see their symptoms as an emergency ((7%) were referred via emergency services).
Conclusion Our research suggests that targeted work addressing help seeking behaviour amongst groups less well represented at TIA clinics might serve to address some inequalities in stroke. However, these differences in access of prevention services are not sufficient to explain the extent of the socioeconomic disparity in disease burden caused by stroke.
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