What is the Optimum Model of Service Delivery for Transient Ischaemic Attack?
Department of Primary Care and General Practice
People who have had a transient ischaemic attack (TIA) are at high risk of subsequently having a stroke, and these risks are greatest in the initial period following the event, with 8% of people going on to have a stroke within a week and 12% within a month.
National Clinical Guidelines for Stroke recommend that patients with a TIA should be investigated as soon as possible in a specialist service within 7 days.
While there is a broad based clinical consensus that management of patients with TIA and minor stroke should be more pro-active than it currently is, it is not possible to recommend a single model of care, since there are a number of unresolved issues.
Should the emphasis be on the development of rapid access specialist clinics (analogous to rapid access chest pain clinics)?
Should this involve a ‘one stop’ service, with same day access to brain scans and carotid ultrasound?
What is the trade off in terms of cost versus outcome if these clinics have the capacity to see all patients on the same day that they are referred, or if there is a maximum wait (e.g. 7 days)?
What would be the impact if more patients with TIA were seen in hospital within a few hours of symptom onset (e.g. if health education campaigns alert people to the symptoms of stroke, and are encouraged to dial ‘999)?
Alternatively, should GPs manage patients more actively, without referring all to specialist clinics?
The aim of this research is to inform how best to configure TIA services by using mathematical modelling.
Four different patterns of service provision will be assessed (current practice;enhanced primary care services; a ‘999' service; and a rapid access neuro-vascular clinic) in terms of strokes averted, quality adjusted life years and costs.
No formal PhD project has been designed as the successful candidate will be involved in its development.
The research will, however, be carried out in the area described above.
Training and support will be provided. The postholder will be based in the Department of Primary Care and General Practice, part of the Division of Primary Care & General Practice, Public and Occupational Health, at the University of Birmingham.
To be eligible for this studentship, applicants must have a class I or II:i degree in a relevant subject.
Application forms are available from Kathleen Waldron, 0121 414 8582, or available online at http://www.apply.bham.ac.uk/.
Please do not complete the section describing the project, as the protocol will be designed by the candidate once in post.
Closing date: 30th November, the stipend is £12,000 per annum plus tuition fees.
Please return application forms to:
Dr Jonathan Mant,
Department of Primary Care & General Practice,
Clinical Sciences Building,
University of Birmingham,
For more information about this project, please contact:
Dr Jonathan Mant on 0121 414 82657, or
email on j.w.mant [at] bham.ac.uk.