Integration of a Pharmacist into a Stroke Prevention Clinic Team: PROGRAM GOALS
The main objective of integrating a clinical pharmacist into the Stroke Prevention Clinic team was to further decrease morbidity and mortality by preventing recurrent stroke. This goal was to be accomplished by attaining the following short-term goals related to modification of risk factors and education of both patients and staff:
• increasing the percentage of patients who adhere to their treatment plans and medications
• increasing the percentage of patients whose blood pressure is controlled
• increasing the number of patients who achieve target cholesterol levels
• increasing the percentage of patients who are receiving appropriate antiplatelet therapy
• increasing the percentage of patients who are tobacco-free
• increasing the number of patients receiving education from a pharmacist
RESOURCE REQUIREMENTS
A 0.4 full-time equivalent pharmacist (A.J.L.) was transferred from the acute stroke unit to the clinic.
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PHARMACIST ACTIVITIES
Patients were seen on “clinic days” 2 afternoons per week. Besides direct patient care activities, the pharmacist participated in ad hoc team education sessions, answered drug information questions from the staff, provided consultations about other patients to the team, and provided telephone follow-up with patients when required.All patients referred to the clinic were eligible for assessment by the pharmacist. A referral from another health care provider was not required for the pharmacist to become involved with individual patients. Before the patient’s appointment at the clinic, the pharmacist systematically reviewed any available medical records, diagnostic, and laboratory information for patients with appointments that day.
The pharmacist performed an assessment after the nurse had assessed the patient, but before the physician did so. The pharmacist used the same examination room as the nurse and had about 15 min for the initial assessment. Using the pharmaceutical care process, the pharmacist completed a medication history with the patient and discussed the patient’s medication experience. The focus of the pharmacist’s activities was on risk-factor modification, such as lipid and blood pressure control, diabetes management, smoking cessation, and optimization of antiplatelet and antithrombotic medications. Any drug-related issues identified and any relevant laboratory parameters were discussed with the patient. Suggestions for changes in drug therapy or monitoring (or both) were then provided to the neurologist and nurse verbally or in writing (in the patient’s medical record). After the physician’s assessment was complete, the pharmacist discussed with the patient any changes that had been made to the treatment plan and provided education about new medications. The patient was referred to the social worker or dietitian as needed. canadian antibiotics
EXPERIENCE TO DATE
The pharmacist was added to the clinic team in January 2006. The direct patient care activities carried out by the pharmacist were quantified and qualified from January to June 2006 as a preliminary determination of the benefits of adding a pharmacist to the Stroke Prevention Clinic team.
