Pharmacy program to improve care for veterans with transient ischaemic attack: a pilot implementation evaluation
Background Early evaluation and effective communication to manage transient ischaemic attacks (TIA) may lead to a reduction of up to 70% in recurrent events for patients with TIA/minor stroke, along with reduced costs and lengths of hospital stay.Methods We conducted a single site pilot evaluation o...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-09-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/11/3/e001863.full |
| _version_ | 1811209801939550208 |
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| author | Dawn M Bravata Laura Myers Anthony J Perkins Teresa M Damush Nicholas Rattray Barbara Homoya Christopher Knefelkamp Breanne Fleming Andrea Kingsolver Amy Boldt Jared Ferguson Alan Zillich |
| author_facet | Dawn M Bravata Laura Myers Anthony J Perkins Teresa M Damush Nicholas Rattray Barbara Homoya Christopher Knefelkamp Breanne Fleming Andrea Kingsolver Amy Boldt Jared Ferguson Alan Zillich |
| author_sort | Dawn M Bravata |
| collection | DOAJ |
| description | Background Early evaluation and effective communication to manage transient ischaemic attacks (TIA) may lead to a reduction of up to 70% in recurrent events for patients with TIA/minor stroke, along with reduced costs and lengths of hospital stay.Methods We conducted a single site pilot evaluation of a clinical pharmacy programme to improve medication management among TIA patients. The programme included a structured protocol, online identification tool, and a templated discharge checklist. Primary effectiveness measures were change in systolic blood pressure (SBP) 90 days post discharge and prescription of high/moderate potency statins. Contextual aspects and clinical perspectives on the implementation process were evaluated through prospective semistructured interviews with key informants.Results The analysis included 75 patients in the preimplementation group and 61 in the postimplementation group. The mean SBP at 90 days post discharge was significantly lower in the post implementation period (pre implementation, 133.3 mm Hg (SD 17.8) vs post implementation, 126.8 mm Hg (16.6); p=0.045). The change in SBP from discharge to 90 days post discharge was greater in the postimplementation period (15.8 mm Hg (20.5) vs 24.8 mm Hg (23.2); p=0.029). The prescription of high/moderate potency statins were similar across groups (pre implementation, 66.7% vs post implementation, 77.4%; p=0.229). Front-line clinicians involved in the pilot study reported positively on the acceptability, appropriateness and feasibility of implementing the protocol without additional cost and within current scope of practice.Conclusions Implementation of a clinical protocol outlining medication management and provider communication to ensure rapid postdischarge treatment of TIA patients was associated with SBP improvements. The pilot evaluation demonstrates how clinical pharmacists may play a role in treating low frequency, high stakes cerebrovascular events where early treatment and follow-up are critical. |
| first_indexed | 2024-04-12T04:45:03Z |
| format | Article |
| id | doaj.art-c80cd7ef2ffc41fdbdda78d6817a0267 |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-04-12T04:45:03Z |
| publishDate | 2022-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-c80cd7ef2ffc41fdbdda78d6817a02672022-12-22T03:47:32ZengBMJ Publishing GroupBMJ Open Quality2399-66412022-09-0111310.1136/bmjoq-2022-001863Pharmacy program to improve care for veterans with transient ischaemic attack: a pilot implementation evaluationDawn M Bravata0Laura Myers1Anthony J Perkins2Teresa M Damush3Nicholas Rattray4Barbara Homoya5Christopher Knefelkamp6Breanne Fleming7Andrea Kingsolver8Amy Boldt9Jared Ferguson10Alan Zillich11Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USAInternal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USAVA HSR&D Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USAInternal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USAInternal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USAVA HSR&D Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USAPharmacy Department, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USAPharmacy Department, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USAPharmacy Department, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USAPharmacy Department, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USAVA HSR&D Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USADepartment of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USABackground Early evaluation and effective communication to manage transient ischaemic attacks (TIA) may lead to a reduction of up to 70% in recurrent events for patients with TIA/minor stroke, along with reduced costs and lengths of hospital stay.Methods We conducted a single site pilot evaluation of a clinical pharmacy programme to improve medication management among TIA patients. The programme included a structured protocol, online identification tool, and a templated discharge checklist. Primary effectiveness measures were change in systolic blood pressure (SBP) 90 days post discharge and prescription of high/moderate potency statins. Contextual aspects and clinical perspectives on the implementation process were evaluated through prospective semistructured interviews with key informants.Results The analysis included 75 patients in the preimplementation group and 61 in the postimplementation group. The mean SBP at 90 days post discharge was significantly lower in the post implementation period (pre implementation, 133.3 mm Hg (SD 17.8) vs post implementation, 126.8 mm Hg (16.6); p=0.045). The change in SBP from discharge to 90 days post discharge was greater in the postimplementation period (15.8 mm Hg (20.5) vs 24.8 mm Hg (23.2); p=0.029). The prescription of high/moderate potency statins were similar across groups (pre implementation, 66.7% vs post implementation, 77.4%; p=0.229). Front-line clinicians involved in the pilot study reported positively on the acceptability, appropriateness and feasibility of implementing the protocol without additional cost and within current scope of practice.Conclusions Implementation of a clinical protocol outlining medication management and provider communication to ensure rapid postdischarge treatment of TIA patients was associated with SBP improvements. The pilot evaluation demonstrates how clinical pharmacists may play a role in treating low frequency, high stakes cerebrovascular events where early treatment and follow-up are critical.https://bmjopenquality.bmj.com/content/11/3/e001863.full |
| spellingShingle | Dawn M Bravata Laura Myers Anthony J Perkins Teresa M Damush Nicholas Rattray Barbara Homoya Christopher Knefelkamp Breanne Fleming Andrea Kingsolver Amy Boldt Jared Ferguson Alan Zillich Pharmacy program to improve care for veterans with transient ischaemic attack: a pilot implementation evaluation BMJ Open Quality |
| title | Pharmacy program to improve care for veterans with transient ischaemic attack: a pilot implementation evaluation |
| title_full | Pharmacy program to improve care for veterans with transient ischaemic attack: a pilot implementation evaluation |
| title_fullStr | Pharmacy program to improve care for veterans with transient ischaemic attack: a pilot implementation evaluation |
| title_full_unstemmed | Pharmacy program to improve care for veterans with transient ischaemic attack: a pilot implementation evaluation |
| title_short | Pharmacy program to improve care for veterans with transient ischaemic attack: a pilot implementation evaluation |
| title_sort | pharmacy program to improve care for veterans with transient ischaemic attack a pilot implementation evaluation |
| url | https://bmjopenquality.bmj.com/content/11/3/e001863.full |
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