Integration of a Pharmacist into a Stroke Prevention Clinic Team: DISCUSSION part 2
Targeted patient outcomes can only be achieved if the prescriber accepts and implements the intervention. In this study, workload data were sometimes entered into the workload management system before an issue had been discussed with the prescriber. As a result, the prescriber’s decision was unknown for 11.6% of the interventions at the time of data entry. Interestingly, about 8% of pharmacists’ recommended interventions were rejected. This value is higher than the 1% to 2% reported in previous research and higher than the 3.2% reported previously from the authors’ institution. One reason for this difference may be the timing of the pharmacist’s assessment of patients, before the neurologist’s assessment, with recommendations being made on the assumption of a stroke- related diagnosis. Thus, for example, the pharmacist might have made recommendations for drug therapy that became irrelevant if the eventual diagnosis was a nonstroke event; this would have increased the number of rejected interventions. In addition, this was a new program for both the pharmacist and the physicians. The proportion of accepted recommendations is expected to increase as team relationships strengthen.
This study had a few limitations. Although the pharmacist intended to assess all patients, this aim could not always be achieved because of time constraints. The pharmacist had to prioritize the list of patients on the basis of a chart review. As such, the pharmacist might not have assessed patients with fewer drug-related issues. As well, the pharmacist made suggestions for changes in drug therapy before the neurologist had assessed the patient, and it is possible that some of the suggestions would have been implemented regardless of the pharmacist’s recommendation. Finally, this retrospective study might have been subject to other, unknown confounders.
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In the future, the staff pharmacists working on the acute stroke team hope to incorporate shifts in the Stroke Prevention Clinic into their clinical practice to allow for continuity of care for stroke survivors who are admitted to hospital. In addition to the duties outlined here, they will continue to maintain a file of evidence-based stroke literature to share with clinic staff. Group teaching sessions for patients and their families are being considered. Consideration is also being given to academic detailing for general practitioners, to provide information about secondary stroke prevention strategies. In addition, studies of actual patient outcomes are warranted, such as achievement of target lipid levels.
CONCLUSIONS
The integration of a pharmacist into an interdisciplinary secondary stroke prevention clinic is supported by the literature on hypertension and dyslipidemia management. Pharmacists are in a key position to provide pharmaceutical care to ambulatory stroke survivors and to identify, prevent, and resolve drug- related issues. The stroke clinic pharmacist in this study initiated 2.8 drug-related interventions per patient encounter. Although this study has outlined the goals of therapy that the pharmacist tries to achieve while caring for patients, further research is needed to determine the effects of pharmacist involvement on patient and team satisfaction with pharmacist services, as well as on stroke risk factors, morbidity, and mortality. canadian pharmacy cialis
