Kim Min Sun, Cleymaet Sean V, Kim Seung, Andres Jennifer, Ruchalski Charles, Kim Yongwoo, Azizi S Ausim, Sharrief Anjail Z, Naqvi Imama A
Neurology, Temple Health, Philadelphia, Pennsylvania, USA.
Department of Neurology, Temple University Hospital, Philadelphia, Pennsylvania, USA.
Integr Healthc J. 2022 Jun 22;4(1):e000118. doi: 10.1136/ihj-2021-000118. eCollection 2022.
Although secondary stroke prevention is important, the optimal outpatient model that improves risk factor control and decreases post-stroke complications effectively has not been established. We created Follow-up After Stroke, Screening and Treatment (FASST), an interdisciplinary clinic involving stroke physicians and pharmacists to address poststroke complications and secondary stroke prevention systemically. We present our approach to assess its proof-of-concept in our pilot study.
We included the patients attending FASST clinic after their hospital discharge. We used validated survey screens to assess for complications: depression, anxiety, sleep disorders, cognitive impairment, disability, social support, quality of life and functional status. Data were collected including risk factors, complication screening results and outcome scores. Clinical pharmacists assessed risk factor control and health-related behaviours for modification.
Of the 25 patients enrolled in the interdisciplinary clinic, all had comorbid hyperlipidaemia and hypertension, and 44% had diabetes mellitus. About one-third needed medication changes for risk factor control. On screening, 16% of patients were found to have depression, 12% had anxiety and 20% had sleep apnoea. These patients were either managed in the clinic or were referred to relevant subspeciality clinics. The status of risk factor control was assessed in all patients, and 32% had medications adjustments.
Our preliminary data found that FASST clinic model is feasible and potentially useful. It represents an integrated approach to post-stroke care, with pharmacist collaboration to improve risk factor control, while assessing for poststroke complications. Further study is needed to improve health outcomes through integrated poststroke care.
尽管二级卒中预防很重要，但尚未建立能有效改善危险因素控制并降低卒中后并发症的最佳门诊模式。我们创建了卒中后随访、筛查与治疗（FASST）门诊，这是一个由卒中医生和药剂师参与的跨学科门诊，旨在系统地解决卒中后并发症和二级卒中预防问题。我们在初步研究中展示了评估其概念验证的方法。
我们纳入了出院后到FASST门诊就诊的患者。我们使用经过验证的调查筛查工具来评估并发症，包括抑郁、焦虑、睡眠障碍、认知障碍、残疾、社会支持、生活质量和功能状态。收集的数据包括危险因素、并发症筛查结果和结局评分。临床药剂师评估危险因素控制情况以及需要改变的健康相关行为。
在纳入该跨学科门诊的25例患者中，所有患者均合并高脂血症和高血压，44%的患者患有糖尿病。约三分之一的患者需要调整药物以控制危险因素。筛查发现，16%的患者有抑郁，12%的患者有焦虑，20%的患者有睡眠呼吸暂停。这些患者要么在门诊接受治疗，要么被转诊至相关专科门诊。对所有患者的危险因素控制情况进行了评估，32%的患者进行了药物调整。
我们的初步数据表明，FASST门诊模式是可行的且可能有用。它代表了一种卒中后综合护理方法，药剂师参与协作以改善危险因素控制，同时评估卒中后并发症。需要进一步研究通过卒中后综合护理来改善健康结局。
