Clinical Pharmacy Department, Methodist University Hospital, Memphis, Tennessee; Methodist University Specialty Clinic, Memphis, Tennessee; University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee; Methodist LeBonheur Healthcare - University Hospital 1265 Union Ave, Memphis, Tennessee.
Methodist LeBonheur Healthcare - University Hospital 1265 Union Ave, Memphis, Tennessee; University of Tennessee Health Science Center, College of Medicine, Department of Neurology, Memphis, Tennessee.
J Stroke Cerebrovasc Dis. 2020 Apr;29(4):104648. doi: 10.1016/j.jstrokecerebrovasdis.2020.104648. Epub 2020 Feb 6.
Stroke impacts nearly 800,000 people annually and the risk of recurrent stroke and hospital readmission is increased early following the initial event. Due to the increase in morbidity and mortality associated with secondary events, a pharmacist-driven poststroke transitions of care clinic was created at Methodist University Hospital to provide risk factor modification in an effort to decrease risk of recurrence and hospital readmissions.
A retrospective matched-cohort study was conducted between 9/1/2017 and 2/28/2019. Adult patients with a primary diagnosis of stroke, discharged to home, and attended a poststroke transitions of care clinic visit were included. Patients were matched on the basis of age ±3 years, race, gender, and type of stroke to those who did not receive pharmacist intervention during the same time period. The primary endpoint was 30-day hospital readmissions. Secondary endpoints included 90-day readmissions, 30 and 90-day emergency department visits, and recurrent stroke rates. Type and quantity of pharmacist interventions was also assessed.
One hundred and eighty-eight patients were included in the analysis. Baseline differences existed between the groups in the following: history of transient ischemic attack, stroke severity score, and insurance status. No significant difference was found in 30-day readmissions. There was a significant difference found in 90-day readmissions (5.3% versus 21.3%, P = .001). There were no significant differences in emergency department utilization at 30 or 90 days or stroke recurrence rates. Pharmacists made a mean of 3.5 interventions made during each visit.
Although the primary goal to reduce 30-day readmission was not met, a pharmacist-driven poststroke transitions of care clinic significantly decreased 90-day hospital readmission rates.
每年有近 80 万人受到中风的影响，并且在首次发病后早期再次中风和再次住院的风险增加。由于与二级事件相关的发病率和死亡率增加，Methodist 大学医院创建了一个由药剂师主导的中风后过渡护理诊所，以提供危险因素的改变，从而降低复发和再次住院的风险。
对 2017 年 9 月 1 日至 2019 年 2 月 28 日期间进行了回顾性匹配队列研究。将出院回家并参加中风后过渡护理诊所就诊的主要诊断为中风的成年患者纳入研究。根据年龄（±3 岁）、种族、性别和中风类型对患者进行匹配，与同期未接受药剂师干预的患者进行匹配。主要终点是 30 天内的再入院率。次要终点包括 90 天内的再入院率、30 天和 90 天的急诊就诊率以及再次中风的发生率。还评估了药剂师干预的类型和数量。
共有 188 名患者纳入分析。两组之间存在以下基线差异：短暂性脑缺血发作史、中风严重程度评分和保险状况。30 天内的再入院率无显著差异。90 天内的再入院率存在显著差异（5.3%比 21.3%，P=0.001）。30 天和 90 天的急诊就诊率或中风复发率无显著差异。药剂师每次就诊平均进行 3.5 次干预。
尽管主要目标是降低 30 天内的再入院率，但由药剂师主导的中风后过渡护理诊所显著降低了 90 天内的住院再入院率。
