Integration of a Pharmacist into a Stroke Prevention Clinic Team: DISCUSSION
This study demonstrated that ambulatory stroke patients experience numerous actual and potential drug-related problems and that pharmacists may be in a key position to identify and resolve these problems. A large number of the pharmacist’s interventions during the study period were related to lack of appropriate pharmacotherapy. Previous research has indicated that 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors are often underutilized in patients with a history of heart disease and stroke. As well, blood pressure is adequately controlled in only 13% of patients with hyperten- sion. Pharmacists may be in an ideal position to review a patient’s risk factors for stroke and to initiate or recommend appropriate pharmacotherapy where indicated.
The American Stroke Association has recommended community education as a method of improving the quality of stroke care. The pharmacist in the DTHR Stroke Prevention Clinic provided 100 private educational sessions to clinic patients. Increased knowledge of stroke risk factors may lead to improved adherence to risk reduction strategies. Adherence may also be affected by an understanding of patients’ medication experiences, the way they “feel, react and think about medications”. Because a person’s medication experience can influence his or her decisions regarding drug therapy, the pharmacist in this study tried to ascertain the patient’s medication experience with every medication reconciliation activity.
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In this study, the pharmacist helped to identify and resolve issues related to drug interactions, dosing problems, and adverse reactions. Preventing and resolving such issues is required to ensure that the pharmacist’s interventions yield positive patient outcomes. In this study, the main outcomes targeted by the pharmacist were clinical and humanistic in nature. Although economic outcomes are also important, they were not assessed in this study, as the current workload management system evaluates only direct drug costs. The collection of further information on economic outcomes is warranted.
