Medication coaching program for patients with minor stroke or TIA: A pilot study

Abstract

BackgroundPatients who are hospitalized with a first or recurrent stroke often are discharged with new medications or adjustment to the doses of pre-admission medications, which can be confusing and pose safety issues if misunderstood. The purpose of this pilot study was to assess the feasibility of medication coaching via telephone after discharge in patients with stroke.MethodsTwo-arm pilot study of a medication coaching program with 30 patients (20 intervention, 10 control). Consecutive patients admitted with stroke or TIA with at least 2 medications changed between admission and discharge were included. The medication coach contacted intervention arm patients post-discharge via phone call to discuss risk factors, review medications and triage patients’ questions to a stroke nurse and/or pharmacist. Intervention and control participants were contacted at 3 months for outcomes. The main outcomes were feasibility (appropriateness of script, ability to reach participants, and provide requested information) and participant evaluation of medication coaching.ResultsThe median lengths of the coaching and follow-up calls with requested answers to these questions were 27 minutes and 12 minutes, respectively, and participant evaluations of the coaching were positive. The intervention participants were more likely to have seen their primary care provider than were control participants by 3 months post discharge.ConclusionsThis medication coaching study executed early after discharge demonstrated feasibility of coaching and educating stroke patients with a trained coach. Results from our small pilot showed a possible trend towards improved appointment-keeping with primary care providers in those who received coaching.

Investigating the transition to home experience for people with mild stroke: the mild stroke transitional experience in Australia

“…The use of technologies has been suggested to improve the accessibility of interventions (Jones et al, 2013). Telephone use is one technology that has been identified as successful in targeting people of a large geographic area and assisting people with mild stroke to have questions answered after return home (Sides et al, 2012).…”

“…Telephone communication is also a convenient, relatively inexpensive, and less resource intensive method of providing services (Sides et al, 2012). Furthermore, research into telehealth has demonstrated that it is met with acceptance by people with mild stroke and is valued to the same degree as face-to-face treatment (Lai, Woo, Hui, & Chan, 2004).…”

“…All three interventions produced limited significant findings, but positive trends were observed. The studies that focussed on secondary prevention demonstrated increased knowledge in accessing healthcare (Sides et al, 2012) and medication (Adie & James, 2010), as well as trends toward lower depression scores, higher reported health status and reduced disability (Sides et al, 2012). Rochette and colleagues' results (2013) were positive from a qualitative perspective in terms of: appreciation of support, better problem solving abilities and increased insight (see Table 3.1).…”

“…Moreover, even if their hospital LOS is longer than this average, people with mild stroke's rehabilitative needs may be hard to identify outside the context of complex activities. This issue has been supported in the wider literature where it has been identified that short hospital stays can inhibit the ability of health professionals to make in-hospital visits to educate patients on vital elements of post-discharge life, such as community reintegration, counselling and problem solving (Tellier & Rochette, 2009), post-discharge self-care (Sides et al, 2009), and risk factors and medications (Sides et al, 2012;Tellier & Rochette, 2009). The difficulties observed in meeting these requirements were outlined in the Stroke Foundation's National Stroke Audit -Acute Services Report (2017), where it was reported that 33% of people with stroke were not assessed by a physiotherapist within 24-48 hours of admission, 14% did not participate in rehabilitation therapy within 48 hours of initial assessment, 10% did not commence treatment for a rehabilitation goal during their acute admission, 35% were not given a written care plan when discharged from acute care, 38% of carers were not assessed in regards to their support needs, and 43% of carers were not provided with training.…”

“…Each of these studies had differing intervention lengths and focal points (Adie & James, 2010;Rochette et al, 2013;Sides et al, 2012). Whilst Sides and colleagues (2012) and Adie and James (2010) both targeted secondary prevention, they approached this slightly differently with one targeting medication management (Prior et al, 2011) and the other focusing on lifestyle change (Sides et al, 2012). Rochette and colleagues (2013) moved away from purely secondary prevention and promoted a problem-solving approach for a wide range of new and ongoing issues.…”