{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T01:37:08Z","timestamp":1783474628833,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T00:00:00Z","timestamp":1668556800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Australian J Rural Health"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare processes of care and clinical outcomes of community\u2010based management of TIAs and minor strokes (TIAMS) between rural and metropolitan Australia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Inception cohort study between 2012 and 2016 with 12\u2010month follow\u2010up after index event (sub\u2010study of INSIST).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Hunter and Manning valley regions of New South Wales, within the referral territory of the John Hunter Hospital Acute Neurovascular Clinic (JHHANC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Consecutive patients of 16 participating general practices, presenting with possible TIAMS to either primary or secondary care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Processes of care (referrals, key management processes, time\u2010based metrics) and clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 613 participants with possible TIAMS who completed the baseline interview, 298 were adjudicated as having TIAMS (119 from rural, 179 from metropolitan). Mean age was 72.3\u2009years (SD, 10.7) and 127 (43%) were women. Rural participants were more likely to be managed solely by a general practitioner (GP) than metropolitan participants (34% v 20%) and less likely to be referred to a JHHANC specialist (13% v 38%) or have brain magnetic resonance imaging (MRI) [24% v 51%]. Those rural participants who were referred, also waited longer (both <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Recurrent stroke, myocardial infarction and death at 12\u2009months were not significantly different between rural and metropolitan participants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although TIAMS prognosis in rural settings where solely GP care is common is very good, the processes of care in such areas are inferior to metropolitan. This suggests there is further scope to support rural GPs to optimise care of TIAMS patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajr.12950","type":"journal-article","created":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T12:33:37Z","timestamp":1668602017000},"page":"274-284","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Rural versus metropolitan comparison of processes of care in the community\u2010based management of TIA and minor stroke in Australia (an analysis from the INSIST study)"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3715-6570","authenticated-orcid":false,"given":"Shyam","family":"Gangadharan","sequence":"first","affiliation":[{"name":"Department of Neurology John Hunter Hospital  Newcastle New South Wales Australia"},{"name":"School of Medicine and Public Health University of Newcastle  Callaghan New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Tomari","sequence":"additional","affiliation":[{"name":"Hunter Medical Research Institute and University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher R.","family":"Levi","sequence":"additional","affiliation":[{"name":"Department of Neurology John Hunter Hospital  Newcastle New South Wales Australia"},{"name":"School of Medicine and Public Health University of Newcastle  Callaghan New South Wales Australia"},{"name":"Hunter Medical Research Institute and University of Newcastle  Newcastle New South Wales Australia"},{"name":"The Sydney Partnership for Health Education, Research and Enterprise  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Weaver","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health University of Newcastle  Callaghan New South Wales Australia"},{"name":"Hunter Medical Research Institute and University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Holliday","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health University of Newcastle  Callaghan New South Wales Australia"},{"name":"Hunter Medical Research Institute and University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Bajorek","sequence":"additional","affiliation":[{"name":"Hunter Medical Research Institute and University of Newcastle  Newcastle New South Wales Australia"},{"name":"Faculty of Health University of Technology Sydney  Broadway New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lasserson","sequence":"additional","affiliation":[{"name":"Warwick Medical School University of Warwick  Warwick UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M.","family":"Valderas","sequence":"additional","affiliation":[{"name":"Department of Family Medicine National University Health System  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen M.","family":"Dewey","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Nursing and Health Sciences, Box Hill Hospital Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Alan","family":"Barber","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil J.","family":"Spratt","sequence":"additional","affiliation":[{"name":"Department of Neurology John Hunter Hospital  Newcastle New South Wales Australia"},{"name":"Hunter Medical Research Institute and University of Newcastle  Newcastle New South Wales Australia"},{"name":"School of Biomedical Sciences and Pharmacy University of Newcastle  Callaghan New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique A.","family":"Cadilhac","sequence":"additional","affiliation":[{"name":"Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health Monash University  Clayton Victoria Australia"},{"name":"Stroke Group Florey Institute of Neuroscience and Mental Health, University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valery L.","family":"Feigin","sequence":"additional","affiliation":[{"name":"Auckland University of Technology, National Institute for Stroke &amp; 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