GPs find post-stroke follow-up difficult due to structural problems at different levels in the healthcare system and difficulties in handling medication adherence, indicating a need for improvement.
Key Findings
Results
GPs identified heavy workload and insufficient time for patients as a key barrier to post-stroke secondary preventive follow-up.
Heavy workload was identified as a primary structural barrier to adequate post-stroke care
GPs touched on solutions including increasing the number of GPs to address this issue
Insufficient time for patients was identified as one of six categories encompassing shortcomings in post-stroke follow-up
The finding emerged from eight focus group discussions with 49 GPs in Region Stockholm
Results
The overarching structure of the healthcare system was identified as a barrier to standardized post-stroke follow-up in primary care.
The healthcare system was described as 'insufficiently organized' for post-stroke care
GPs reported that the healthcare system does not facilitate standardized follow-up of patients
Shortcomings in the internal structure of follow-ups were identified as a distinct category of barriers
GPs identified improved referrals from hospital to primary care as a needed solution
The fragmented nature of the Swedish healthcare system was central to the theme 'Multifaceted mission in an insufficiently organized healthcare system'
Results
Medication adherence after stroke was identified as complex and challenging, with unclear responsibility for medication lists and a lack of tools to improve adherence.
Two separate categories related to medication adherence were identified: 'the responsibility for renewals of medication' and 'tools for adherence'
Unclear responsibility for the medication list was identified as a key contributor to adherence difficulties
Lack of tools to improve adherence was highlighted as a distinct shortcoming
Adherence challenges were captured under the theme 'The complexity of adherence'
Medical adherence was one of six categories encompassing shortcomings in post-stroke follow-up
Background
There is up to fourfold variation in dispensation of secondary preventive drugs between different primary care units in Region Stockholm.
Low target achievement and up to fourfold practice variation in dispensation of secondary preventive drugs between primary care units has been described in Region Stockholm
Although several factors in individual practices have been observed to be associated with insufficient target achievements, the underlying reasons for this variation were unclear prior to this study
This variation provided the motivation for exploring GP perspectives on secondary preventive practices after stroke
Methods
The study identified two overarching themes and six categories describing GP perspectives on barriers to post-stroke secondary prevention.
Eight focus group discussions were conducted with 49 GPs in Region Stockholm
GPs were strategically invited in relation to target achievement levels
Interviews lasted 45–55 minutes and used a semi-structured interview guide
Interviews were transcribed and analysed using qualitative content analysis
The two themes were: 'Multifaceted mission in an insufficiently organized healthcare system' and 'The complexity of adherence'
Six categories encompassed shortcomings in: sufficient time for patients, overarching structure of the healthcare system, internal structure of follow-ups, medical adherence, responsibility for renewals of medication, and tools for adherence
Results
GPs identified education and improved hospital-to-primary-care referrals as potential solutions to barriers in post-stroke follow-up.
Solutions mentioned by GPs included increasing the number of GPs, education, and improved referrals from hospital to primary care
These solutions were discussed in the context of addressing structural problems at different levels of the healthcare system
The qualitative study design allowed GPs to articulate both barriers and potential areas of improvement
What This Means
This research suggests that general practitioners (GPs) in Sweden face significant structural and organizational barriers when trying to provide follow-up care for stroke survivors. The study, which involved focus group discussions with 49 GPs in the Stockholm region, found that heavy workloads leave insufficient time for stroke patients, and the healthcare system itself is poorly organized to support consistent, standardized follow-up care. Notably, there is already known to be up to a fourfold difference between primary care clinics in how often they prescribe medications that help prevent a second stroke, but until this study, the reasons behind that variation were not well understood.
The research also highlights that managing patients' long-term medication after a stroke is complicated by unclear responsibility — it is often not well defined which healthcare provider is responsible for maintaining and renewing a patient's medication list. GPs also reported lacking practical tools to help patients stick with their prescribed medications over time. These findings fall under two broad themes: the complexity of the healthcare mission within a fragmented system, and the difficulty of managing medication adherence.
This research suggests that improving post-stroke care in primary care settings will require changes at multiple levels, including hiring more GPs to reduce workload, providing better education, strengthening handover processes when patients are discharged from hospital to primary care, and developing clearer systems for medication management. The study points to systemic, rather than purely individual, explanations for why some clinics achieve better stroke prevention outcomes than others.
Wolf M, Flink M, Carlsson A, von Euler M, Hasselström J. (2026). Barriers for general practitioners in post-stroke follow-up within a fragmented healthcare system in Sweden - a focus group study.. The European journal of general practice. https://doi.org/10.1080/13814788.2026.2728342