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Education Campaign Increases Stroke Survival in Texas
Study finds benefits continue even after campaign ends
A study based in three Texas counties shows that a focused educational campaign aimed at the public and health professionals produced a sustained increase in lifesaving care for stroke patients.
In the Oct. 13 issue of the Archives of Internal Medicine, researchers from The University of Texas Medical School at Houston and the University of Michigan Cardiovascular Center reported that a threeyear community campaign led to a five times greater use of an emergency clot-busting drug in stroke patients in three Texas counties, resulting in 69 percent of eligible patients receiving it. A sustained increase in acute stroke therapies was not seen in two comparable Texas counties, where the campaign was not carried out.
“I think the importance of this study is twofold,” said James C. Grotta, M.D., who holds the Roy M. and Phyllis Gough Huffington Distinguished Chair in Neurology at the UT Medical School at Houston and is an author of the study. “It shows that acute stroke therapy can be carried out in small rural hospitals, not just major metropolitan hospitals. Also, when you intervene to change people’s behaviors, that change can last long past the time the education takes place. Even after the program was completed, the benefits continued.”
The study focused on patients receiving the drug tPA (tissue plasminogen activator) within three hours of the onset of a stroke. Since its introduction in 1996, tPA has helped tens of thousands of stroke victims who received it within three hours of the onset of their symptoms. By breaking up the blood clots that cause 80 percent of strokes by clogging the brain’s blood vessels, tPA reduces the risk of brain damage, disability and death from the stroke.
Despite national guidelines to help doctors quickly decide how to diagnose and treat acute stroke, a low rate of optimum care persists. In addition to killing more than 167,000 Americans a year, stroke permanently disables many victims, making it the top cause of disability in the nation.
For the Texas study, researchers set out to break down many barriers to acute stroke care through education and training. They measured the effects of their effort by analyzing medical records at the five hospitals in the three Texas counties (Angelina, Shelby and Nacogdoches) that were targeted for intervention. In order to be sure the campaign was having an effect, the team also analyzed records at five hospitals in a nearby comparison area – Jefferson and Orange counties.
The team targeted both the public and the health care community at once, educating them on many aspects of stroke treatment, including recognizing stroke symptoms, calling 911 immediately to seek medical attention, asking for acute stroke therapies in the emergency room and understanding the benefit of rapid treatment.
The research team used radio and television public service announcements, newspaper articles, brochures, billboards, posters and volunteer training sessions to spread the word about tPA and other appropriate therapies. They also developed treatment guidelines to aid emergency department doctors and emergency medical services staff, conducted continuing medical education classes, and used physician newsletters to highlight the success of acute stroke treatment.
During the first phase of the study, before the education campaign was launched, 424 patients in the targeted areas had suffered strokes. Of those, only 2.2 percent of the patients in the intervention community, and 14 percent of those deemed eligible for tPA treatment by national guidelines, received tPA. In the comparison communities, the percentages receiving tPA were 0.71 percent of all stroke patients and 7 percent of eligible patients.
During Phase II, when the education campaign was in full swing and 765 patients had strokes, the intervention counties began to see a dramatic rise in tPA use. Among all stroke patients, 8.65 percent got tPA, including 52 percent of all the eligible patients. Meanwhile, just 0.86 percent of stroke victims and 6 percent of all eligible patients in the comparison counties received tPA.
When the education campaign concluded, the team monitored medical records for six more months during Phase III, during which 238 more people had validated strokes. The effect of the education drive kept growing, with 11.25 percent of stroke patients in intervention communities getting tPA, including 69 percent of all eligible patients. In the comparison communities, tPA was given to only 1.43 percent of all stroke patients and just 20 percent of the eligible patients.
In addition to Grotta and lead author Lewis Morgenstern, M.D., stroke program director at the University of Michigan, the research team included UT Medical School at Houston research assistants Lara Staub and Mary King and UT School of Public Health at Houston faculty L. Kay Bartholemew, Ed.D., associate professor of behavioral sciences, and Wenyaw Chan, Ph.D., professor of biometry. The study was conducted while Morgenstern was a member of the UT Medical School at Houston faculty.
The $1.5 million research project was funded by the TLL Temple Foundation.
— by Shannon Rasp, Public Affairs