Stroke “Coach” Helps Patients Stay on Preventative Medications, Provides Early Warning of Post-Stroke Problems

October 28, 2010

When stroke neurologist Cheryl Bushnell, M.D.,led a national study of stroke patients in Adherence Evaluation After Ischemic Stroke –Longitudinal (AVAIL) last spring, she and her colleagues found that nearly 20 percent of those patients had stopped taking one or more of the medications that prevent a second stroke; 3.5 percent were not taking any medication at all at three months.

“My passion is to try to prevent recurrent stroke,” Bushnell noted, “and to understand the patients’ and caregivers’ perspectives and the barriers and areas where we can intervene to make sure people have the knowledge and resources to keep taking their medications. Hopefully, we as providers can improve our patients’ medication compliance through better communications and by being aware of the factors associated with medication discontinuation.”

Three months ago, Bushnell, the director of Wake Forest University Baptist Medical Center’s Stroke Center, set out to do just that. She has undertaken a pilot study, following a group of 35 post-stroke patients and, with the help of a team made up of a pharmacist, a nurse, and a trained medication “coach”, hopes to keep this patient group on their medications and stroke-free for the next year.

The pharmacist and the nurse are available for immediate medication and medical consults if a patient inquiry requires it. 

The stroke medication coach is trained to assess whether the patient is taking all of their prescribed medicine, and taking it correctly, during a post-discharge phone call. The patient-coach conversation is a series of prompts meant to confirm that the patient knows the name, dosing information, indication, and side effects of each medication. While the coach’s prompting and repetition ensures that the patient is familiar with their medicines, it’s also a chance for the coach to listen for signs of fatigue or mental confusion in the patient.  The coach also asks whether the patient has had any falls or other problems that might signal neurological decline.

Initial findings from the pilot found that a majority of the patients knew the reason for taking a particular medication but could not name the medication’s side effects.  “In addition, half of the patients had questions about their stroke or their medications and this coaching program enabled us to provide the answers to their questions in a timely fashion,” Bushnell reported.

“The coaching process is really like a window into the lives of our patients after they have left the hospital,” said Bushnell. “It allows us an opportunity to address little things that often improve a patient’s quality of life, such as changing the time when a medication is taken or letting a patient know that it is better to take a particular medication with food to avoid an upset stomach.  It’s these small adjustments that increase the likelihood that a patient will stay on their medications.  My hope is that this innovative approach to post stroke care proves effective and is replicated at medical centers and hospitals across the country.”

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