Pharmacists Improved Stroke Patient Care

Stroke patients may maintain better blood pressure and cholesterol with pharmacist involvement

(RxWiki News) Those who have a stroke or even a mini-stroke face greater odds of a bigger stroke, heart attack or dying. When pharmacists play a role in counseling patients, these heart risk factors may improve.

To reduce the chances of having a cardiovascular event following a stroke, patients are advised to lower high blood pressure and maintain healthy cholesterol levels. Management of these conditions, however, is often not as good as it should be.

A new Canadian study has found that patients who have a pharmacist managing their care may have better results in controlling risk factors and avoiding negative events compared to those who do not receive pharmacist counseling.

"Consider making a pharmacist a part of your healthcare team."

Finlay McAlister, MD, in the Division of General Internal Medicine and the Epidemiology Coordinating and Research (EPICORE) Centre at University of Alberta in Canada, collaborated on this research on 279 stroke patients.

At the beginning of the study, participants — who had an average age of 67 and a half and 58 percent of whom were men — had blood pressure and cholesterol levels that were not healthy, according to Canadian Stroke Guidelines.

Over a six-month period, either a pharmacist or nurse had a monthly visit with each patient.

Both the pharmacists and nurses measured blood pressure and LDL (“bad” cholesterol) levels, and shared results with primary care physicians. They also gave advice on diet, smoking, exercise and other lifestyle factors.

Pharmacists took an additional step in prescribing medications as recommended by Canadian guidelines, and actively adjusting those prescriptions on an individual basis to achieve desired results.  

While both patient groups had significant improvements in their cardiovascular risk factors after six months, the pharmacist group fared better than the nurse group. In the pharmacist case manager group, about 43 percent of individuals met both blood pressure and cholesterol guideline targets, compared with 31 percent in the nurse-led group.

Dr. McAlister told dailyRx News, “I think our study shows that case management by non-physician health care providers can improve vascular risk factor management for at-risk patients, and that case management is more effective if the case manager can actively modify medications rather than just feedback risk factor levels to patients and/or their primary care physicians.”

E. Lee Carter, RPh, clinical pharmacy specialist with the Department of Veterans Affairs at the Huntington VA Medical Center in Prestonsburg, Kentucky, added that pharmacist-managed hypertension control has previously been evaluated in other studies and has generally proven to be very effective.

“Traditionally, non-compliance with therapy has been identified as a major contributor to patients' ineffective hypertensive and lipid [fats in the blood] control,” Carter told dailyRx News. “Clinical pharmacy services can have a significant impact on compliance and patient satisfaction, and thus on drug therapy outcomes. Pharmacists' unique knowledge of various drug classes, potential drug interactions, and proper dosing of antihypertensive and cholesterol lowering medications would be most valuable in managing these disease states. I would encourage patients to query their primary-care provider about the addition of a pharmacist to their healthcare team.”

This study was published April 14 in CMAJ (Canadian Medical Association Journal). Project-specific funding for this trial was provided by the Heart and Stroke Foundation of Alberta, the Alberta Heritage Foundation for Medical Research and Knowledge Translation Canada.

Review Date: 
April 14, 2014