14 Apr After Stroke: Pharmacist Led Case Management Improved Blood Pressure Control
MedicalResearch.com Interview with:
Finlay A McAlister MD
University of Alberta, Edmonton, Canada
MedicalResearch.com: What are the main findings of the study?
Dr. McAlister: We tested 2 systems of case management on top of usual care (note that at baseline more than 3/4 of our study patients were already taking medications to lower blood pressure (BP) and/or cholesterol but none were at guideline-recommended targets).
The first (our “control” group) was a nurse seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians with advice to patients who had blood pressure or cholesterol above guideline-recommended targets to see their primary care physician.
The second (our “intervention” group) was a pharmacist seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians. However, if patients had blood pressure or cholesterol above guideline-recommended targets instead of just recommending that the patient see their primary care physician the pharmacist provided them with a prescription for medication (or up-titration of their current medications) to address the uncontrolled risk factor.
Both groups improved substantially over usual care, but the intervention group improved even more (13% absolute improvement in control of BP/cholesterol levels compared to the nurse-led control arm) .
MedicalResearch.com What should clinicians and patients take away from your report?
Dr. McAlister:Stroke/TIA (minor stroke) is a warning sign for future cardiovascular events including bigger strokes, heart attacks, or death.
Current system of care results in more than 3/4 of patients who’ve had a stroke/TIA still having inadequately controlled vascular risk factors even 6 months later.
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.
MedicalResearch.com What recommendations do you have for future research as a result of this study?
Dr. McAlister: Future studies should test whether active case management works for other “at risk” populations and to evaluate different “doses” of active case management – are monthly visits required or could less frequent visits confer the same benefits?
Case management for blood pressure and lipid level control after minor stroke:
Finlay A. McAlister, Sumit R. Majumdar, Raj S. Padwal, Miriam Fradette, Ann Thompson, Brian Buck, Naeem Dean, Jeffrey A. Bakal, Ross Tsuyuki, Steven Grover, and Ashfaq Shuaib
CMAJ cmaj.140053; published ahead of print April 14, 2014, doi:10.1503/cmaj.140053