1
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Hwang Y, Lee G. [Experiences of Transitional Care for Medicaid Case Managers]. J Korean Acad Nurs 2023; 53:556-569. [PMID: 37977565 DOI: 10.4040/jkan.23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/27/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE This phenomenological study tried to understand the essence of the transitional care experience of medicaid case managers and its structural meaning. In addition, it was attempted to establish a system of transitional care and seek support measures for medicaid case managers. METHODS The participants of this study were 7 medicaid case managers who had spent more than 1 year and 6 months in medicaid pilot project. Data were collected with individual in-depth interviews from June to December 2021. The data were analyzed by Giorgi's phenomenological analysis method. RESULTS The seven constituents derived from the results of this study were 'struggle to establish a living environment', 'dedication to supporting independent living', 'anxiety about safety', 'pressure on care responsibilities', 'distress in building the pilot project', 'pride in role', and 'expectation for improvement'. CONCLUSION The study results provide a comprehensive understanding of the transition care reality for medicaid case managers. They also shed light on managers' perceptions and attitudes. These findings can serve as fundamental information for establishing support measures for medicaid case managers and transitional care systems.
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Affiliation(s)
- Yunhee Hwang
- College of Nursing, Dong-A University, Busan, Korea
| | - Gaeon Lee
- College of Nursing, Dong-A University, Busan, Korea.
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Rossi LP, Granger BB, Bruckel JT, Crabbe DL, Graven LJ, Newlin KS, Streur MM, Vadiveloo MK, Walton-Moss BJ, Warden BA, Volgman AS, Lydston M. Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association. Circulation 2023; 148:512-542. [PMID: 37427418 DOI: 10.1161/cir.0000000000001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.
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Al-Qahtani S, Jalal Z, Paudyal V, Mahmood S, Mason J. The Role of Pharmacists in Providing Pharmaceutical Care in Primary and Secondary Prevention of Stroke: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10112315. [PMID: 36421639 PMCID: PMC9691113 DOI: 10.3390/healthcare10112315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/05/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022] Open
Abstract
Pharmacists deliver pharmaceutical care in many different healthcare settings and are well-placed to support the prevention of stroke. However, their role and impact in this area is ill-defined. This systematic review aims to explore the pharmacists’ role in stroke prevention. Nine databases were searched for studies reporting pharmacist interventions in the management of primary and secondary ischaemic stroke prevention. Study quality was evaluated through Cochrane Risk of Bias and Joanna Briggs Institute (JBI) appraisal tools where possible. A narrative review was conducted and meta-analysis performed for studies with comparable outcomes. Of the 834 initial articles, 31 met inclusion criteria. Study designs were varied and included controlled trials, observational studies, audit reports and conference abstracts. Seven studies addressed the pharmacists’ role in primary prevention and 24 in secondary prevention. Pharmacist interventions reported were diverse and often multifactorial. Overall, 20 studies reported significant improvement in outcomes. Meta-analysis showed pharmacist interventions in emergency care significantly improved the odds of achieving thrombolytic therapy door to needle (DTN) times ≤45 min, odds ratio: 2.69 (95% confidence interval (CI): 1.95−3.72); p < 0.001. The pharmacists’ role is varied and spans the stroke treatment pathway, with the potential for a positive impact on a range of health-related outcomes.
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Affiliation(s)
- Saeed Al-Qahtani
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
- School of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
- Correspondence: ; Tel.: +966-560742224
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Vibhu Paudyal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Sajid Mahmood
- Department of Pharmacy, Quaid-i-Azam University, Islamabad 45320, Pakistan
| | - Julie Mason
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Golla H, Dillen K, Hellmich M, Dojan T, Ungeheuer S, Schmalz P, Staß A, Mildenberger V, Goereci Y, Dunkl V, Strupp J, Fink GR, Voltz R, Stock S, Cornely O, Stahmann A, Müller A, Löcherbach P, Burghaus L, Limmroth V, Bonmann E, Gerbershagen K, Nelles G, Joist T, Haas J, Temmes H, Warnke C. Communication, Coordination, and Security for People with Multiple Sclerosis (COCOS-MS): a randomised phase II clinical trial protocol. BMJ Open 2022; 12:e049300. [PMID: 35078833 PMCID: PMC8796263 DOI: 10.1136/bmjopen-2021-049300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patients with multiple sclerosis (MS) have complex needs that range from organising one's everyday life to measures of disease-specific therapy monitoring to palliative care. Patients with MS are likely to depend on multiple healthcare providers and various authorities, which are often difficult to coordinate. Thus, they will probably benefit from comprehensive cross-sectoral coordination of services provided by care and case management (CCM). Though studies have shown that case management improves quality of life (QoL), functional status and reduces service use, such benefits have not yet been investigated in severely affected patients with MS. In this explorative phase ll clinical trial, we evaluated a CCM with long-term, cross-sectoral and outreaching services and, in addition, considered the unit of care (patients and caregivers). METHODS AND ANALYSIS Eighty patients with MS and their caregivers will be randomly assigned to either the control (standard care) or the intervention group (standard care plus CCM (for 12 months)). Regular data assessments will be done at baseline and then at 3-month intervals. As primary outcome, we will evaluate patients' QoL. Secondary outcomes are patients' treatment-related risk perception, palliative care needs, anxiety/depression, use of healthcare services, caregivers' burden and QoL, meeting patients' and caregivers' needs, and evaluating the CCM intervention. We will also evaluate CCM through individual interviews and focus groups. The sample size calculation is based on a standardised effect of 0.5, and one baseline and four follow-up assessments (with correlation 0.5). Linear mixed models for repeated measures will be applied to analyse changes in quantitative outcomes over time. Multiple imputation approaches are taken to assess the robustness of the results. The explorative approach (phase ll clinical trial) with embedded qualitative research will allow for the development of a final design for a confirmative phase lll trial. ETHICS AND DISSEMINATION The trial will be conducted under the Declaration of Helsinki and has been approved by the Ethics Commission of Cologne University's Faculty of Medicine. Trial results will be published in an open-access scientific journal and presented at conferences. TRIAL REGISTRATION NUMBER German Register for Clinical Studies (DRKS) (DRKS00022771).
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Affiliation(s)
- Heidrun Golla
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Kim Dillen
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Solveig Ungeheuer
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Petra Schmalz
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Angelika Staß
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Vanessa Mildenberger
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Yasemin Goereci
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Veronika Dunkl
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
- Cognitive Neuroscience, Institute of Neurosciences and Medicine, Jülich, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Oliver Cornely
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Alexander Stahmann
- MS-Registry by the German MS-Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Anne Müller
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Peter Löcherbach
- German Society for Care and Case Management (DGCC), Mainz, Germany
| | - Lothar Burghaus
- Department of Neurology, Heilig Geist-Krankenhaus Köln, Cologne, Germany
| | | | | | | | - Gereon Nelles
- NeuroMed Campus, MedCampus Hohenlind, Cologne, Germany
| | - Thomas Joist
- Academic Teaching Practice, University of Cologne, Cologne, Germany
| | - Judith Haas
- German Multiple Sclerosis Society Federal Association (DMSG), Hannover, Germany
| | - Herbert Temmes
- German Multiple Sclerosis Society Federal Association (DMSG), Hannover, Germany
| | - Clemens Warnke
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
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Miller MJ, Pammett RT. A scoping review of research on Canadian team-based primary care pharmacists. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:106-115. [PMID: 33729533 DOI: 10.1093/ijpp/riaa021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES An ageing population with an increasing prevalence of chronic disease and complex medication regimens has placed a strain on healthcare systems in Canada. A limited number of team-based primary care pharmacists are integrated into primary care clinics across the country, working alongside other members of the health care team to identify and resolve drug therapy problems and improve outcomes. While many studies have been completed in the area, the extent of research on integrated team-based primary care pharmacists in Canada is unknown. The objectives of this work were to describe the literature that exists surrounding pharmacists in a primary health care team setting in Canada. A scoping review of research focusing on pharmacists in team-based primary health care settings in Canada was performed. Thematic analysis was then performed to categorize the identified studies. KEY FINDINGS The search identified 874 articles, of which 93 met inclusion criteria relevant to the objective. From these 93 studies, 4 themes and 23 subthemes were identified, with some studies having more than one theme or subtheme. Themes identified were the following: primary care pharmacist scope of practice (n = 79 studies), collaboration/communication within the primary care setting (n = 26), chronic disease management (n = 24) and 'other' (n = 15). SUMMARY This research quantified and categorized 93 studies on pharmacists in interprofessional primary care teams in Canada. As this is an expanding role for pharmacists in Canada, understanding the current state of the literature is an important consideration when developing future team-based primary care roles.
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Affiliation(s)
| | - Robert T Pammett
- Northern Health Authority, Prince George, British Columbia, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Hill J, Harrison J, Raj S, Gregary B, Timoroksa AM, Gibson J. Mediators, confounders and effectiveness of interventions for medication adherence after stroke. BRITISH JOURNAL OF NEUROSCIENCE NURSING 2020; 16:S18-S24. [PMID: 38737446 PMCID: PMC7615945 DOI: 10.12968/bjnn.2020.16.sup5.s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
After a stroke, people are left with an increased risk of recurrence. One of the primary methods of prevention is the use of a range of medications, but adherence to these is often low. This article evaluates and summarises three systematic reviews that investigate possible underlying reasons for this and how to overcome these barriers.
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Affiliation(s)
- James Hill
- Health Technology Assessment Group, University of Central Lancashire
| | - Joanna Harrison
- Health Technology Assessment Group, University of Central Lancashire
| | - Sonia Raj
- NIHR Lancashire Clinical Research Facility, Royal Preston Hospital
| | - Bindu Gregary
- NIHR Lancashire Clinical Research Facility, Royal Preston Hospital
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Abstract
Stroke is the acute onset of neurological deficits and is associated with high morbidity, mortality, and disease burden. In the present study, we aimed to develop a scientific, nomogram for non-invasive predicting risk for early ischemic stroke, in order to improve stroke prevention efforts among high-risk groups. Data were obtained from a total of 2151 patients with early ischemic stroke from October 2017 to September 2018 and from 1527 healthy controls. Risk factors were examined using logistic regression analyses. Nomogram and receiver operating characteristic (ROC) curves were drawn, cutoff values were established. Significant risk factors for early ischemic stroke included age, sex, blood pressure, history of diabetes, history of genetic, history of coronary heart disease, history of smoking. A nomogram predicting ischemic stroke for all patients had an internally validated concordance index of 0.911. The area under the ROC curve for the logistic regression model was 0.782 (95% confidence interval [CI]: 0.766-0.799, P < .001), with a cutoff value of 2.5. The nomogram developed in this study can be used as a primary non-invasive prevention tool for early ischemic stroke and is expected to provide data support for the revision of current guidelines.
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Affiliation(s)
| | | | - Ce Zhang
- Clinical Drug Trial Institution, The Second Hospital of Dalian Medical University, Dalian, China
| | - Rui Shi
- Clinical Drug Trial Institution, The Second Hospital of Dalian Medical University, Dalian, China
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Padwal RS, So H, Wood PW, Mcalister FA, Siddiqui M, Norris CM, Jeerakathil T, Stone J, Valaire S, Mann B, Boulanger P, Klarenbach SW. Cost-effectiveness of home blood pressure telemonitoring and case management in the secondary prevention of cerebrovascular disease in Canada. J Clin Hypertens (Greenwich) 2018; 21:159-168. [DOI: 10.1111/jch.13459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/29/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Raj S. Padwal
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
- Mazankowski Heart Institute; Edmonton Alberta Canada
| | - Helen So
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Peter W. Wood
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Finlay A. Mcalister
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
- Mazankowski Heart Institute; Edmonton Alberta Canada
| | - Muzaffar Siddiqui
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Colleen M. Norris
- Mazankowski Heart Institute; Edmonton Alberta Canada
- Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network; Edmonton Alberta Canada
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Tom Jeerakathil
- Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network; Edmonton Alberta Canada
| | - James Stone
- Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network; Edmonton Alberta Canada
| | - Shelley Valaire
- Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network; Edmonton Alberta Canada
| | - Balraj Mann
- Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network; Edmonton Alberta Canada
| | - Pierre Boulanger
- Department of Computing Science; University of Alberta; Edmonton Alberta Canada
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Toell T, Boehme C, Mayer L, Krebs S, Lang C, Willeit K, Prantl B, Knoflach M, Rumpold G, Schoenherr G, Griesmacher A, Willeit P, Ferrari J, Lang W, Kiechl S, Willeit J. Pragmatic trial of multifaceted intervention (STROKE-CARD care) to reduce cardiovascular risk and improve quality-of-life after ischaemic stroke and transient ischaemic attack -study protocol. BMC Neurol 2018; 18:187. [PMID: 30400876 PMCID: PMC6219064 DOI: 10.1186/s12883-018-1185-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/21/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients with ischaemic stroke or transient ischaemic attack (TIA) are at high risk of future cardiovascular events. Despite compelling evidence about the efficacy of secondary prevention, a substantial gap exists between risk factor management in real life and that recommended by international guidelines. Moreover, stroke is a leading cause of disability and morbidity which partly emerges from post-stroke complications. METHODS/DESIGN We designed a block-randomised (2:1 ratio) open pragmatic trial [NCT02156778] with blinded outcome assessment comparing STROKE-CARD to usual post-stroke-patient care. STROKE-CARD is a multifaceted post-stroke disease management program with the objective of reducing recurrent cardiovascular events and improving quality of life in ischaemic stroke and TIA-patients. It combines intensified multi-domain secondary prevention, systematic detection and treatment of post-stroke complications, and patient self-empowerment. Enrolment of 2160 patients with acute ischaemic stroke or TIA (ABCD2-Score ≥ 3) is planned at two study centres in Austria. The co-primary efficacy endpoints are (i) the composite of major recurrent cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, and vascular death) occurring within 12 months after the index event and (ii) one-year health-related quality-of-life measured with the European Quality of Life-5 Dimensions (EQ-5D-3 L) questionaire. Secondary endpoints include all-cause mortality, functional outcome, and target-level achievement in risk factor management. DISCUSSION This trial will provide evidence on whether the pragmatic post-stroke intervention program STROKE-CARD can help prevent cardiovascular events and improve quality-of-life within the setting of a high-quality acute stroke care system. In case of success, STROKE-CARD may be implemented in daily clinical routine and serve as a model for other disease management initiatives. TRIAL REGISTRATION ClinicalTrials.gov: NCT02156778 . (June 5, 2014, retrospectively registered).
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Affiliation(s)
- Thomas Toell
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Lukas Mayer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Stefan Krebs
- Department of Neurology, Hospital St. John of God, Johannes von Gott Platz 1, A-1020 Vienna, Austria
| | - Clemens Lang
- Department of Neurology, Hospital St. John of God, Johannes von Gott Platz 1, A-1020 Vienna, Austria
| | - Karin Willeit
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
- Department of Neurology, Inselspital Bern, University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Barbara Prantl
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Gerhard Rumpold
- Department of Medical Psychology, Medical University of Innsbruck, Schöpfstraße 23a, A-6020 Innsbruck, Austria
| | - Gudrun Schoenherr
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Peter Willeit
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Julia Ferrari
- Department of Neurology, Hospital St. John of God, Johannes von Gott Platz 1, A-1020 Vienna, Austria
| | - Wilfried Lang
- Department of Neurology, Hospital St. John of God, Johannes von Gott Platz 1, A-1020 Vienna, Austria
- Sigmund Freud Private University, Medical Faculty, Campus Prater Freudplatz 1, A-1020 Vienna, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
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Bridgwood B, Lager KE, Mistri AK, Khunti K, Wilson AD, Modi P. Interventions for improving modifiable risk factor control in the secondary prevention of stroke. Cochrane Database Syst Rev 2018; 5:CD009103. [PMID: 29734470 PMCID: PMC6494626 DOI: 10.1002/14651858.cd009103.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Stroke services need to be configured to maximise the adoption of evidence-based strategies for secondary stroke prevention. Smoking-related interventions were examined in a separate review so were not considered in this review. This is an update of our 2014 review. OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2017), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2017), CENTRAL (the Cochrane Library 2017, issue 3), MEDLINE (1950 to April 2017), Embase (1981 to April 2017) and 10 additional databases including clinical trials registers. We located further studies by searching reference lists of articles and contacting authors of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. DATA COLLECTION AND ANALYSIS Four review authors selected studies for inclusion and independently extracted data. The quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (GRADEpro GDT).Three review authors assessed the risk of bias for the included studies. We sought missing data from trialists.The results are presented in 'Summary of findings' tables. MAIN RESULTS The updated review included 16 new studies involving 25,819 participants, resulting in a total of 42 studies including 33,840 participants. We used the Cochrane risk of bias tool and assessed three studies at high risk of bias; the remainder were considered to have a low risk of bias. We included 26 studies that predominantly evaluated organisational interventions and 16 that evaluated educational and behavioural interventions for participants. We pooled results where appropriate, although some clinical and methodological heterogeneity was present.Educational and behavioural interventions showed no clear differences on any of the review outcomes, which include mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events. There was moderate-quality evidence that organisational interventions resulted in improved blood pressure control, in particular an improvement in achieving target blood pressure (odds ratio (OR) 1.44, 95% confidence interval (CI) 1.09 to1.90; 13 studies; 23,631 participants). However, there were no significant changes in mean systolic blood pressure (mean difference (MD), -1.58 mmHg 95% CI -4.66 to 1.51; 16 studies; 17,490 participants) and mean diastolic blood pressure (MD -0.91 mmHg 95% CI -2.75 to 0.93; 14 studies; 17,178 participants). There were no significant changes in the remaining review outcomes. AUTHORS' CONCLUSIONS We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events.
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Affiliation(s)
- Bernadeta Bridgwood
- Department of Health Sciences, University of Leicester, University Road, Leicester, UK, LE1 7RH
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11
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Mendyk AM, Duhamel A, Bejot Y, Leys D, Derex L, Dereeper O, Detante O, Garcia PY, Godefroy O, Montoro FM, Neau JP, Richard S, Rosolacci T, Sibon I, Sablot D, Timsit S, Zuber M, Cordonnier C, Bordet R. Controlled Education of patients after Stroke (CEOPS)- nurse-led multimodal and long-term interventional program involving a patient's caregiver to optimize secondary prevention of stroke: study protocol for a randomized controlled trial. Trials 2018; 19:137. [PMID: 29471839 PMCID: PMC5824577 DOI: 10.1186/s13063-018-2483-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Setting up a follow-up secondary prevention program after stroke is difficult due to motor and cognitive impairment, but necessary to prevent recurrence and improve patients' quality of life. To involve a referent nurse and a caregiver from the patient's social circle in nurse-led multimodal and long-term management of risk factors after stroke could be an advantage due to their easier access to the patient and family. The aim of this study is to compare the benefit of optimized follow up by nursing personnel from the vascular neurology department including therapeutic follow up, and an interventional program directed to the patient and a caregiving member of their social circle, as compared with typical follow up in order to develop a specific follow-up program of secondary prevention of stroke. METHODS/DESIGN The design is a randomized, controlled, clinical trial conducted in the French Stroke Unit of the Strokavenir network. In total, 410 patients will be recruited and randomized in optimized follow up or usual follow up for 2 years. In both group, patients will be seen by a neurologist at 6, 12 and 24 months. The optimized follow up will include follow up by a nurse from the vascular neurology department, including therapeutic follow up, and a training program on secondary prevention directed to the patient and a caregiving member of their social circle. After discharge, a monthly telephone interview, in the first year and every 3 months in the second year, will be performed by the nurse. At 6, 12 and 24 month, the nurse will give the patient and caregiver another training session. Usual follow up is only done by the patient's general practitioner, after classical information on secondary prevention of risk factors during hospitalization. The primary outcome measure is blood pressure measured after the first year of follow up. Blood pressure will be measured by nursing personnel who do not know the group into which the patient has been randomized. Secondary endpoints are associated mortality, morbidity, recurrence, drug side-effects and medico-economic analysis. DISCUSSION The result of this trial is expected to provide the benefit of a nurse-led optimized multimodal and long-term interventional program for management of risk factors after stroke, personalizing the role of the nurse and including the patient's caregiver. TRIAL REGISTRATION ClinicalTrials.gov, NCT 02132364. Registered on 7 May 2014. EUDRACT, A 00473-40.
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Affiliation(s)
- Anne-Marie Mendyk
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France
| | - Alain Duhamel
- University Lille, CHU, EA2694, F-59000, Lille, France
| | - Yannick Bejot
- University Hospital and Medical School of Dijon, University of Burgundy, Digon, France
| | - Didier Leys
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France
| | - Laurent Derex
- Department of Stroke Medicine, Université Lyon 1, Lyon, France
| | - Olivier Dereeper
- Stroke Unit, Neurology Department, Calais Hospital, Calais, France
| | - Olivier Detante
- Université Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France
| | - Pierre-Yves Garcia
- Stroke Unit, Neurology Department, Compiègne Hospital, Compiègne, France
| | - Olivier Godefroy
- Department of Neurology and Functional Neuroscience Laboratory EA 4559, Amiens University Medical Center, Amiens, France
| | | | - Jean-Philippe Neau
- Department of Neurology, CHU of Poitiers, University of Poitiers, Poitiers, France
| | - Sébastien Richard
- Stroke unit, Department of Neurology, CHU of Nancy, Lorraine University, Nancy, France
| | - Thierry Rosolacci
- Stroke Unit, Neurology Department, Maubeuge Hospital, Maubeuge, France
| | - Igor Sibon
- Department of Neurology, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Denis Sablot
- Stroke Unit, Neurology Department, Perpignan Hospital, Perpignan, France
| | - Serge Timsit
- CHRU Brest, Department of Neurology and Stroke Unit, Université de Bretagne Occidentale, Brest, France
| | - Mathieu Zuber
- Department of Neurology, Saint-Joseph Hospital Center, AP - HP, Université Paris-Descartes, INSERM UMR S 919, Paris, France
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France
| | - Régis Bordet
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France.
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Abstract
BACKGROUND Pharmacists have become an integral member of the multidisciplinary team providing clinical patient care in various healthcare settings. Although evidence supporting their role in the care of patients with other disease states is well-established, minimal literature has been published evaluating pharmacist interventions in stroke patients. The purpose of this systematic review is to summarize the evidence evaluating the impact of pharmacist interventions on stroke patient outcomes. METHODS Study abstracts and full-text articles evaluating the impact of a pharmacist intervention on outcomes in patients with an acute stroke/transient ischemic attack (TIA) or a history of an acute stroke/TIA were identified and a qualitative analysis performed. RESULTS A total of 20 abstracts and full-text studies were included. The included studies provided evidence supporting pharmacist interventions in multiple settings, including emergency departments, inpatient, outpatient, and community pharmacy settings. In a significant proportion of the studies, pharmacist care was collaborative with other healthcare professionals. Some of the pharmacist interventions included participation in a stroke response team, assessment for thrombolytic use, medication reconciliation, participation in patient rounds, identification and resolution of drug therapy problems, risk-factor reduction, and patient education. Pharmacist involvement was associated with increased use of evidence-based therapies, medication adherence, risk-factor target achievement, and maintenance of health-related quality of life. CONCLUSIONS Available evidence suggests that a variety of pharmacist interventions can have a positive impact on stroke patient outcomes. Pharmacists should be considered an integral member of the stroke patient care team.
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Faux SG, Arora P, Shiner CT, Thompson-Butel AG, Klein LA. Rehabilitation and education are underutilized for mild stroke and TIA sufferers. Disabil Rehabil 2017; 40:1480-1484. [DOI: 10.1080/09638288.2017.1295473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Steven G. Faux
- Department of Rehabilitation Medicine, St Vincent’s Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Pooja Arora
- Department of Rehabilitation Medicine, St Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Christine T. Shiner
- Department of Rehabilitation Medicine, St Vincent’s Hospital, Sydney, New South Wales, Australia
| | | | - Linda A. Klein
- Sydney Medical School, University of Sydney, New South Wales, Australia
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