An Electronic Referral Initiative to Facilitate Referral to a Chronic Disease Self-Management Program for Persons with Transient Ischemic Attack

Abstract

Background Transient ischemic attack (TIA) is a strong predictor of subsequent stroke. Measures to decrease stroke incidence following TIA include medical management, risk factor optimization, and lifestyle modification. Best practice recommendations for stroke care promote individualized education on self-management across transitions from hospital to community settings. In the study region, patients with TIA are referred to the stroke prevention clinic where they receive rapid stroke assessment, risk factor management, education, and referral to risk reduction programs. Long-term management is typically the responsibility of primary care providers who may have limited resources for self-management support. Promotion of existing chronic disease self-management (CDSM) programs can complement this support.

Objective The objective of our project was to examine the feasibility and acceptability of an electronic referral system to an existing CDSM program to facilitate self-management support for persons with TIA.

Methods We performed a descriptive evaluation of a quality improvement project that involved development and implementation of a new electronic referral (eReferral) process. A partnership between the stroke prevention clinic and the regional Living Healthy CDSM program was developed alongside a clinical information system redesign implementing an eReferral system.

Results Referral to the Living Healthy CDSM program was offered to each patient at the stroke prevention clinic. Of 912 patients seen over a 6-month period, 62 (7%) agreed to be referred. Of these, 23 (37%) were registered or waitlisted.

Conclusion Formation of a partnership and implementation of the eReferral system facilitated referral to the Living Healthy CDSM program. Despite low referral and enrollment rates, the eReferral system provides one option to enhance self-management support for persons with TIA.

Keywords

electronic referral - self-management - transient ischemic attack - quality improvement

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