Abstract:Patients undergoing rehabilitation experience numerous changes in medication regimens during care transitions, exposing these patients to an increased risk of drug-related problems (DRPs). A prospective, non-randomized, quasi-experimental study was conducted in medical rehabilitation wards to evaluate the impact of pharmacist-delivered interventions and counseling on 30-day unplanned health care utilization and medication adherence for selected rehabilitation patients. A pharmacist provided medication reconciliation and counseling before discharge. Phone follow-up was completed 30 days after discharge to assess for unplanned health care utilization rate and medication adherence. A total of 85 patients (n = 43 in prospective intervention group and n = 42 in historical usual care group) were included. Among the intervention group, 23 DRPs were identified in 14 (32.6%) patients, resulting in 51 interventions. The intervention group had a significantly lower unplanned health care utilization rate than the usual care group (25.6% vs. 47.6%, p = 0.035). The risk of unplanned health care utilization was reduced by over 60% (Odds ratio (OR) = 0.378; 95% CI = 0.15-0.94). Patients reporting medium to high medication adherence increased from 23.6% to 88.4% 30 days after counseling (p < 0.05). Pharmacist medication reconciliation and discharge counseling reduced unplanned health care utilization 30 days after discharge and improved medication adherence.

Background Stroke has profound impacts on families. Often, family members, including stroke survivors and the person who takes up the role of the primary caregiver, would encounter demands on finances, rehabilitation arrangement, and even conflicts. Hence, a family-oriented intervention is expected to enable families to rebuild internal and external resources to achieve optimal rehabilitation and community reintegration. Objective This study aims to describe a design of a two-tier family-oriented care management intervention for enhancing the family functioning and care capacity of the caregivers of stroke survivors. Methods The two-tier care management intervention was guided by a standardized protocol conducted by trained professional care managers (first tier) with the support of trained volunteers (second tier), which lasted for 8-12 weeks. Participants were recruited through collaborating hospitals according to inclusion and exclusion criteria. In order to examine the effectiveness and cost-effectiveness of the two-tier care management intervention, a two-arm randomization multicenter study was designed, including an active comparison group, which was guided by a standardized protocol conducted by trained volunteers. Dyadic participants, including both stroke survivors and their primary caregivers for both groups, were invited to participate in a questionnaire survey using standardized and purposefully developed measures 3 times: before the intervention, immediately after the intervention, and 2 months after the intervention. The primary outcome was family functioning measured by the Family Role Performance Scale and Family Assessment Device-General Functioning Scale. The secondary outcomes included caregiving burden, depressive symptoms, care management strategies, and the incremental cost-effectiveness ratio. Results Recruitment began in January 2017 and was completed at the end of April 2019. Data collection was completed at the end of March 2020. As of March 2020, enrollment has been completed (n=264 stroke caregivers). A total of 200 participants completed the baseline questionnaires. We aim to publish the results by mid-2021. Conclusions This study successfully developed a two-tier care management protocol that aims to enhance the family functioning of the caregivers of stroke survivors. Guided by a standardized protocol, this family-oriented two-tier intervention protocol was found to be feasible among Chinese families. Trial Registration ClinicalTrials.gov NCT03034330; https://ichgcp.net/clinical-trials-registry/NCT03034330 International Registered Report Identifier (IRRID) RR1-10.2196/16703

BACKGROUND Stroke brings about abrupt and immense changes to stroke families’ dynamics and responsibilities. Adaptation to new family roles is challenging, as support for caregivers of stoke survivors is minimal, presenting a major obstacle towards restoring family functioning and maximizing care capacity. OBJECTIVE This study aims to implement and examine the effectiveness of a two-tier family- oriented intervention involving care managers and volunteers for enhancing family functioning and care capacity of family caregivers of stroke survivors. METHODS This is a multicenter, two-armed, randomized, controlled study (intervention group, n=150; control group, n=150). Following case referral from hospital, family caregivers of stroke survivors and stroke survivors provide informed consent and undergo initial screening. Caregivers report significant caregiver burden, and/or depressive mood, and/or family dysfunctioning are randomly assigned to undergo two-tier family-oriented intervention (intervention group) or psychoeducation (control group). The primary outcome is the change in i) family role performance, ii) family caregiver conflict, iii) care management strategies, and iv) general family functioning from baseline to 2 weeks and 2 months after completion of intervention. RESULTS This study began in January 2017 and is being conducted at three participating facilities in Hong Kong. CONCLUSIONS This study will examine the effectiveness of a two-tier family- oriented intervention in enhancing family functioning and care capacity of family caregivers of stroke survivors. Through this study, we expect that this intervention can fill the service gap in the current stroke care system and serves as an important basis on which future evidence-based programs supporting family caregivers of stroke survivors could develop. CLINICALTRIAL ClinicalTrials.gov NCT03034330; https://ichgcp.net/clinical-trials-registry/NCT03034330