Through-train care model on stroke patients in Caritas Medical Centre, KWC:Impact of pharmaceutical care on stroke prevention

Abstract Description

Presentation Upload :

Authors (including presenting author) :

To YT(1), Wong WY (2), Lo WY (2), Kwong CL (2), Cheung PY (1),Fung PP(1), Wong ML (2)

Affiliation :

(1) Department of Pharmacy, Caritas Medical Centre (2) Department of Medicines & Geriatrics

Introduction :

Clinical pharmacist is part of the multi-disciplinary team of stroke unit in Caritas Medical Centre (CMC) since 2014. Roles of clinical pharmacist have then expanded. The through-train care model with clinical pharmacist has been established since 2016.

Objectives :

To recognize service gaps and challenges of medication use in stroke patients To evaluate the impact of pharmaceutical care on stroke prevention

Methodology :

Pharmaceutical care in CMC stroke patients starts from acute stroke unit (ASU), to rehabilitation ward and till discharge. The care continues at post-discharge medical integrated clinic (MIC). Pharmacist intervenes on high-risk patient and enhancing stroke prevention. Patients who have been hospitalized in acute stroke unit (ASU) of CMC from 01/2016 to 08/2018 were included. Subjects were evaluated on the 1) drug compliance at admission with regimen recall and 2) drug-related problems identified if any, which were classified with PCNE V 7. Patients who attended the post-discharge integrated clinic with pharmacist were further evaluated on drug compliance with DRUGS. Patients were followed up in CDARS for one year after discharge. Stroke recurrence was counted if patients had then admitted to any HA hospital with a principal diagnosis of CVA. The incidence of recurrent stroke in discharged stroke patients was evaluated with Kruskal-Wallis test. Numbers of discharged ischemic stroke patients with atrial fibrillation on anticoagulants between 05/2013-12/2015 and 01/2016 - 08/2018 were evaluated with chi-square test.

Result & Outcome :

A total of 2152 subjects were included. 5% (107/2152) of them were identified with poor drug compliance at admission. 772 drug-related problems were identified. Prevalence of drug-related problem was one in every 3.4 patients. Physician acceptance rate was 91.3%. 12% of discharged patients in MIC clinic were identified with drug compliance problem. Percentage of anticoagulation on discharged ischemic stroke patients with atrial fibrillation in reviewed period was is 59.8% (153/256) compared to 32.9% from May 2013 to Dec 2015 (114/346). The difference in the numbers of discharged ischemic stroke patients on anticoagulant between 05/2013-12/2015 and 01/2016 - 08/2018 was statistically significant. (p<0.05) Progressive decline in stroke recurrence rate was observed within one-year of discharged episodes (7.7% in 2016 and 7.4% in 2017, compared to 7.8% - 10.5% in 2013-2015). The difference in one-year stroke recurrence rate from 2012 to 2017 was statistically significant. (p<0.05) Further study is warranted to evaluate the impact. Pharmaceutical care in through-train model of CMC stroke patients might have contributed to increased percentage of stroke patients with atrial fibrillation on anticoagulants. Our teamwork could have contributed to the reduction in one-year stroke recurrence rate.