Integrating neurology and pharmacy through telemedicine: A novel care model

Li, Hanlin; Naqvi, Imama; Tom, Sarah E.; Almeida, Barbara Santos de; Baratt, Yuliya; Ulane, Christina

doi:10.1016/j.jns.2021.120085

Cited by 4 publications

(3 citation statements)

References 12 publications

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Section: Discussionmentioning

confidence: 99%

“…36 Integrating tele-pharmacists early post-discharge as part of multidisciplinary team visits with other providers may reduce patient burden of recurring visits, and reduce clinical inertia through collaborative drug therapy management for stroke patients. 37,38 In addition to race, education, income, zip code poverty, health insurance, social isolation, and residence have been reported as social determinants affecting incident stroke. 39 We found these to be prevalent in our population, among intervention and usual care arms.…”

Section: Transition Of Care With Multidisciplinary Teams In An Unders...mentioning

confidence: 99%

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Telehealth After Stroke Care Pilot Randomized Trial of Home Blood Pressure Telemonitoring in an Underserved Setting

Naqvi

Strobino

Cheung

et al. 2022

Stroke

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Background: Hypertension is the most important modifiable stroke risk factor, but blood pressure (BP) remains poorly controlled after stroke, especially among Black and Hispanic patients. We tested the feasibility of TASC (Telehealth After Stroke Care), a post-acute stroke care model integrating nurse-supported home BP telemonitoring, tailored infographics, and multidisciplinary team video visits. Methods: Acute stroke patients with hypertension were randomized at discharge to usual care or usual care with TASC. Usual care patients received video visits with primary care and stroke. TASC included a tablet and monitor to wirelessly transmit BP data to the electronic health record, with telenursing support, tailored infographics to explain BP readings, and pharmacist visits. Outcomes assessment was blinded. Feasibility outcomes included recruitment, randomization, adherence, and retention. Systolic BP from baseline to 3 months after discharge was evaluated using generalized linear modeling. Results: Fifty patients (64±14 years; 36% women‚ 44% Hispanic, 32% Black, 54% ≤high school education, 30% private insurance), and 75% of all eligible were enrolled over 6.3 months. Baseline systolic BP was similar in both (TASC n=25, 140±19 mm Hg; usual care n=25, 142±19 mm Hg). At 3 months, adherence to video visits (91% versus 75%, P =0.14) and retention (84% versus 64%, P =0.11) were higher with TASC. Home systolic BP declined by 16±19 mm Hg from baseline in TASC and increased by 3±24 mm Hg in usual care ( P =0.01). Among Black patients, systolic BP control (<130 mm Hg) improved from 40% to 100% with TASC versus 14% to 29%, and among Hispanic patients, from 23% to 62% with TASC, versus 33% to 17% in usual care. Conclusions: Enhancing post-acute stroke care with home BP telemonitoring is feasible to improve hypertension in an underserved setting and should be tested in a definitive randomized clinical trial. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04640519.

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Section: Discussionmentioning

confidence: 99%

Section: Transition Of Care With Multidisciplinary Teams In An Unders...mentioning

confidence: 99%

Telehealth After Stroke Care Pilot Randomized Trial of Home Blood Pressure Telemonitoring in an Underserved Setting

Naqvi

Strobino

Cheung

et al. 2022

Stroke

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“…The CUIMC Comprehensive Stroke Center refers patients post-discharge with Medicare/Medicaid to the Ambulatory Care Network (ACN) stroke clinic. Our hospital’s ACN, serving a predominantly Hispanic, and Black low-income urban population, started to provide telehealth general neurology visits with tele-pharmacy support to identify gaps in medication education and reconciliation before the coronavirus pandemic [ 61 ].…”

Section: Methodsmentioning

confidence: 99%

TASC (Telehealth After Stroke Care): a study protocol for a randomized controlled feasibility trial of telehealth-enabled multidisciplinary stroke care in an underserved urban setting

Naqvi

Cheung

Strobino

et al. 2022

Pilot Feasibility Stud

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Background Hypertension is the most important modifiable risk factor for recurrent stroke, and blood pressure (BP) reduction is associated with decreased risk of stroke recurrence. However, hypertension remains poorly controlled in many stroke survivors. Black and Hispanic patients have a higher prevalence of uncontrolled BP and higher rates of stroke. Limited access to care contributes to challenges in post-stroke care. Telehealth After Stroke Care (TASC) is a telehealth intervention that integrates remote BP monitoring (RBPM) including nursing telephone support, tailored BP infographics and telehealth video visits with a multidisciplinary team approach including pharmacy to improve post-stroke care and reduce stroke disparities. Methods In this pilot trial, 50 acute stroke patients with hypertension will be screened for inclusion prior to hospital discharge and randomized to usual care or TASC. Usual care patients will be seen by a primary care nurse practitioner at 1–2 weeks and a stroke neurologist at 1 and 3 months. In addition to these usual care visits, TASC intervention patients will see a pharmacist at 4 and 8 weeks and will be enrolled in RBPM consisting of home BP monitoring with interval calls by a centralized team of telehealth nurses. As part of RBPM, TASC patients will be provided with a home BP monitoring device and electronic tablet that wirelessly transmits home BP data to the electronic health record. They will also receive tailored BP infographics that help explain their BP readings. The primary outcome will be feasibility including recruitment, adherence to at least one video visit and retention rates. The clinical outcome for consideration in a subsequent trial will be within-patient change in BP from baseline to 3 months after discharge. Secondary outcomes will be medication adherence self-efficacy and satisfaction with post-stroke telehealth, both measured at 3 months. Additional patient reported outcomes will include depression, cognitive function, and socioeconomic determinants. Multidisciplinary team competency and fidelity measures will also be assessed. Conclusions Integrated team-based interventions may improve BP control and reduce racial/ethnic disparities in post-stroke care. TASC is a post-acute stroke care model that is novel in providing RBPM with tailored infographics, and a multidisciplinary team approach including pharmacy. Our pilot will determine if such an approach is feasible and effective in enhancing post-stroke BP control and promoting self-efficacy. Trial registration ClinicalTrials.gov NCT04640519

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Synchronous telepharmacy models of care for adult outpatients: A systematic review

Snoswell,

De Guzman,

Neil

et al. 2025

Research in Social and Administrative Pharmacy

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Integrating neurology and pharmacy through telemedicine: A novel care model

Cited by 4 publications

References 12 publications

Telehealth After Stroke Care Pilot Randomized Trial of Home Blood Pressure Telemonitoring in an Underserved Setting

Telehealth After Stroke Care Pilot Randomized Trial of Home Blood Pressure Telemonitoring in an Underserved Setting

TASC (Telehealth After Stroke Care): a study protocol for a randomized controlled feasibility trial of telehealth-enabled multidisciplinary stroke care in an underserved urban setting

Synchronous telepharmacy models of care for adult outpatients: A systematic review

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