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Open Access Study protocol

Supporting Treatment decision making to Optimise the Prevention of STROKE in Atrial Fibrillation: The STOP STROKE in AF study. Protocol for a cluster randomised controlled trial

Melina Gattellari12, John M Worthington134*, Dominic Y Leung35 and Nicholas Zwar2

Author Affiliations

1 Ingham Institute, Liverpool, Australia

2 School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia

3 South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia

4 Department of Neurology, Liverpool Health Service, South Western Sydney Local Health Network, Liverpool, Australia

5 Department of Cardiology, Liverpool Health Service, South Western Sydney Local Health Network, Liverpool, Australia

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Implementation Science 2012, 7:63  doi:10.1186/1748-5908-7-63

Published: 6 July 2012

Abstract

Background

Suboptimal uptake of anticoagulation for stroke prevention in atrial fibrillation has persisted for over 20 years, despite high-level evidence demonstrating its effectiveness in reducing the risk of fatal and disabling stroke.

Methods

The STOP STROKE in AF study is a national, cluster randomised controlled trial designed to improve the uptake of anticoagulation in primary care. General practitioners from around Australia enrolling in this ‘distance education’ program are mailed written educational materials, followed by an academic detailing session delivered via telephone by a medical peer, during which participants discuss patient de-identified cases. General practitioners are then randomised to receive written specialist feedback about the patient de-identified cases either before or after completing a three-month posttest audit. Specialist feedback is designed to provide participants with support and confidence to prescribe anticoagulation. The primary outcome is the proportion of patients with atrial fibrillation receiving oral anticoagulation at the time of the posttest audit.

Discussion

The STOP STROKE in AF study aims to evaluate a feasible intervention via distance education to prevent avoidable stroke due to atrial fibrillation. It provides a systematic test of augmenting academic detailing with expert feedback about patient management.

Trial registration

Australian Clinical Trials Registry Registration Number: ACTRN12611000076976.

Keywords:
Atrial fibrillation; General practice; Anticoagulation; Decisional support