Abstract
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.
Key Words
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Article info
Publication history
Published online: February 04, 2020
Accepted:
January 1,
2020
Received in revised form:
December 29,
2019
Received:
October 16,
2019
Footnotes
All work was performed under the Clinical Pharmacy Department at Methodist LeBonheur Healthcare – University Hospital and Methodist University Specialty Clinic.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104648
Copyright
© 2020 Elsevier Inc. All rights reserved.
