After being discharged from hospital, stroke patients are often faced with having to deal with a new disability or lack of function, which can make changes in medications or a new prescription particularly confusing. This can lead to various complications, such as taking the wrong medications, forgetting to take medication or to overmedicate, all of which can result in being readmitted to hospital.
A pilot study published online in the July 25 issue of the journal BMC Public Health has investigated new ways to discharge stroke patients, and it appears that patients benefit from phone calls and conversations with a ‘stroke coach’.
Cheryl D. Bushnell, M.D., associate professor of neurology and director of Wake Forest Baptist’s Primary Stroke Center calls for a better hospital-to-home transition, saying:
“Many patients are not only overwhelmed with the new diagnosis of stroke, but also the risk factors that might be uncovered during the stroke hospital stay. This means new medications or adjustments to the old ones. Most important, all of the stroke education we give to people in the hospital before going home may be forgotten with everything else that happens during the hospital stay, so getting some additional teaching after getting home could help this transition.”
Bushnell and her team followed 30 discharged stroke patients who had two or more medication changes from the time they were admitted to hospital until their discharge. The patients were divided into two groups with the first 20 patients being selected to have a ‘stroke coach’, whilst the remainder of the patients had no additional coaching.
Before the patients in the coach group were discharged from hospital, the coach reviewed information with each patient and their caregiver, which included details about when to call 911, their physician and/or pharmacist, as well as lifestyle suggestions to prevent stroke. They also went over a checklist of the individual patient’s risk factors and detailed information about each factor and a list of their current medications, including dosage and what the medication is for. Those in the coach group also received a call from their coach within 2 weeks after being discharged in which the coach provided the patients with general stroke information, the importance of preventing another event and taking the prescribed medication, as well as how they can mitigate their individual stroke risk factors.
The coach also assessed whether each participant fully understood their discharge orders by reviewing each stroke prevention medication on the patient’s discharge list, and asked whether the patient cohered to their drug regime and questioned them if they did not. The coach also checked whether each patient understood the reason for having to take each particular medication. This included questioning the patient how they take their medication, refill it, and if they know the drug’s side effects. Before the call came to an end, each patient was asked whether they had any specific questions regarding their medication or stroke recovery.
After each call, the coach forwarded medication-related questions to a pharmacist and those that were stroke-related to a stroke nurse, before compiling the answers and calling the patient back to relay the information. The responses were also summarized and sent to the participant’s primary care provider. In addition, the coach summarized any lengthy answers in simple language and sent these to the appropriate patient in a follow-up letter.
Three months later an interviewer contacted all patients to survey how they coped. The team found that the differences in terms of knowledge about stroke and medications both groups fared relatively equal, with only a marginal difference between the two groups, but in terms of problems or worsening of symptoms, 93.8% in the coaching group and only 77.8% of those in the control group knew what to do. They also noted that a considerably higher percentage of coaching patients (93.8%) had seen their primary care provider since discharge, compared with only 60% of patients in the control group. Furthermore, those in the coaching group tended to have lower depression severity scores, higher reported health status scores and lesser disability than patients in the control group.
The researchers are aware the limitations of their study due to the small patient population. However, they believe that the overwhelmingly positive feedback with regard to the post-discharge coaching, the feasibility of adding this element to discharge plans, and the early influence on keeping follow-up appointments with their primary care providers demonstrate that programs, such as this seems to be of benefit to stroke victims.
Written by Grace Rattue