Evidence map›Paper›PMID 37283975›Full record

ArticleThe Lancet regional health. Western Pacific2023

The population effect of a national policy to incentivize chronic disease management in primary care in stroke: a population-based cohort study using an emulated target trial approach.

Nadine E Andrew, David Ung, Muideen T Olaiya, Lachlan L Dalli, Joosup Kim, Leonid Churilov, Vijaya Sundararajan, Amanda G Thrift, Dominique A Cadilhac, Mark R Nelson and 4 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet regional health. Western Pacific, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed
5.1field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 24 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 5 institutions in 1 country.

Nadine E AndrewDepartment of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia.
David UngDepartment of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia.
Muideen T OlaiyaDepartment of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Lachlan L DalliDepartment of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Joosup KimDepartment of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Leonid ChurilovMelbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
Vijaya SundararajanDepartment of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.
Amanda G ThriftDepartment of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Dominique A CadilhacDepartment of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Mark R NelsonMenzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
Natasha A LanninDepartment of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Rebecca BarndenDepartment of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia.
Velandai SrikanthDepartment of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia.
Monique F KilkennyDepartment of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
The University of Melbourne · AUMonash University · AUAlfred Health · AUMonash Health · AUUniversity of Tasmania · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Governments are investing in primary care policies that support chronic disease management. Large scale population-based evaluations are lacking. We aim to determine the effectiveness of government-funded chronic disease management policies to improve long-term outcomes (survival, hospital presentations, and preventive medication adherence) following stroke/Transient Ischemic Attack (TIA). Methods: Using a population-based cohort we utilized the target trial methodology. Participants were identified through the Australian Stroke Clinical Registry (January 2012-December 2016) from 42 hospitals in the states of Victoria and Queensland and linked with state and national hospital, primary care, pharmaceutical, aged care, and death datasets. Registrants living in the community, not receiving palliative care and who survived to 18 months following stroke/TIA were included. The comparison was a Medicare claim for policy-supported chronic disease management, 7-18 months following stroke/TIA versus usual care. Outcomes were modelled using multi-level, mixed-effects inverse probability of treatment weighted regression. Findings: 12,368 registrants were eligible (42% female, median age 70 years, 26% TIA), 45% had a chronic disease management claim. The difference in mean outcomes for participants with a claim, compared to those without, showed a 26% lesser mortality rate (adjusted hazard ratio [aHR]: 0.74, 95% confidence interval [CI]: 0.62, 0.87) and a greater adjusted Odds Ratio [aOR] of being adherent with preventive medications: antithrombotics (aOR: 1.16, 95% CI: 1.07, 1.26); lipid-lowering (aOR: 1.23, 95% CI: 1.13, 1.33). Impacts on hospital presentations were variable. Interpretation: Government policies that financially support primary care physicians to provide structured chronic disease management improve survival in the long-term following stroke/TIA. Funding: National Health and Medical Research Council Australia.

Indexed as

Chronic disease managementData linkagePrimary careStrokeTarget trial

Identifiers

PMID37283975
PMCPMC10240379
OpenAlexW4323824578

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.