Background: Stroke impacts nearly 800,000 people annually and the risk of recurrent stroke and hospital readmission is increased early following the initial event. Due to the increase in morbidity and mortality associated with secondary events, a pharmacist-driven poststroke transitions of care clinic was created at Methodist University Hospital to provide risk factor modification in an effort to decrease risk of recurrence and hospital readmissions. Methods: A retrospective matched-cohort study was conducted between 9/1/2017 and 2/28/2019. Adult patients with a primary diagnosis of stroke, discharged to home, and attended a poststroke transitions of care clinic visit were included. Patients were matched on the basis of age ±3 years, race, gender, and type of stroke to those who did not receive pharmacist intervention during the same time period. The primary endpoint was 30-day hospital readmissions. Secondary endpoints included 90-day readmissions, 30 and 90-day emergency department visits, and recurrent stroke rates. Type and quantity of pharmacist interventions was also assessed. Results: One hundred and eighty-eight patients were included in the analysis. Baseline differences existed between the groups in the following: history of transient ischemic attack, stroke severity score, and insurance status. No significant difference was found in 30-day readmissions. There was a significant difference found in 90-day readmissions (5.3% versus 21.3%, P = .001). There were no significant differences in emergency department utilization at 30 or 90 days or stroke recurrence rates. Pharmacists made a mean of 3.5 interventions made during each visit. Conclusions: Although the primary goal to reduce 30-day readmission was not met, a pharmacist-driven poststroke transitions of care clinic significantly decreased 90-day hospital readmission rates.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Stroke and Cerebrovascular Diseases
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Pharmacists as care providers for stroke patients: a systematic review.Can J Neurol Sci. 2018 Jan; 45: 49-55
- Effect of pharmacy-supported transition-of-care interventions on 30-day readmissions: a systematic review and meta-analysis.Ann Pharmacother. 2017; 51: 866-889
- Development of a collaborative transitions-of-care program for heart failure patients.Am J Health Syst Pharm. 2015; 72: 1147-1152
- Pharmacist intervention to improve medication adherence in heart failure.Ann Intern Med. 2007; 146: 714-725
- Adverse drug events occurring following hospital discharge.J Gen Intern Med. 2005; 20: 317-323
- STAAR: improving the reliability of care coordination and reducing hospital readmissions in an academic medical center.BMJ Innov. 2015; 1: 75-80
- Bridging gaps in care: implementation of a pharmacist-led transitions-of-care program.Am J Health Syst Pharm. 2018; 75: S1-S5
- Control of modifiable risk factors in ischemic stroke outpatients by pharmacist intervention: an equal allocation stratified randomized study.J Clin Pharm Ther. 2008; 33: 529-535
- Heart disease and stroke statistics-2016 update: a report from the American Heart Association.Circulation. 2015; 133: e38-e360
- Can readmission after stroke be prevented? Results of a randomized clinical study: a post-discharge follow-up service for stroke survivors.Stroke. 2000; 31: 1038-1045
- HCUP Projections: Cardiovascular/Cerebrovascular Conditions and Procedures 2011-2012. HCUP Projection Report #2012-02.US Agency for Healthcare Research and Quality, July 2012
- All-Cause Readmissions by Payer and Age, 2009-2013. HCUP Statistical Brief #199.US Agency for Healthcare Research and Quality, December 2015
- A review of the role of the pharmacist in heart failure transition of care.Adv Ther. 2018; 35: 311-323
- Evaluation of a transitional care pharmacist intervention in a high-risk cardiovascular patient population.Am J Health Syst Pharm. 2018; https://doi.org/10.2146/ajhp170099
- Evaluation of pharmacist care for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.Int J Clin Pharm. 2014; 36: 1230-1240
- Evaluation of pharmacist medication education and post-discharge follow-up in reducing readmissions in patients with ST-segment elevation myocardial infarction (STEMI).Ann Pharmacother. 2016; 50: 118-124
- Pharmacists’ Impact on Secondary Stroke Prevention.J Pharm Pract. 2018; https://doi.org/10.1177/0897190018766944
Published online: February 04, 2020
Accepted: January 1, 2020
Received in revised form: December 29, 2019
Received: October 16, 2019
All work was performed under the Clinical Pharmacy Department at Methodist LeBonheur Healthcare – University Hospital and Methodist University Specialty Clinic.
© 2020 Elsevier Inc. All rights reserved.