Pharmaceutical care for patients with ischemic stroke: improving the patients quality of life.
OBJECTIVE
To improve patients health-related quality of life (HQL) after transient ischemic attack (TIA) or ischemic stroke; to guarantee an effective secondary prevention; to increase the patient's satisfaction with recommendations regarding their medication by pharmacists.


METHODS
Stroke Unit, neurological ward at the Klinikum Fulda, rehabilitation hospitals and community-based pharmacies in the region of Fulda, Germany.


METHODS
Patients with TIA or ischemic stroke were included. The patients were assigned to an intervention group (IG) or a control group (CG). The individual assignment of patients to IG or CG was based on the type of the local pharmacy to which patients belong. Community-based pharmacies either delivered standard care (CG) or provided additional intensified pharmaceutical care (PC; IG). Pharmacies delivering PC belong to a pre-existing "Quality Assurance Working Group" (QAWG). To evaluate the patient's HQL, the Short Form-36 (SF-36) was used at study entry in hospital and at 12 months. The secondary prevention was documented at study entry in hospital and at 12 months. The patients' satisfaction was measured by a questionnaire at the end of the study.


METHODS
Patients' HQL; secondary prevention; patients' satisfaction with recommendations of the pharmacists with regards to their medication.


RESULTS
Out of 1316 patients screened for participation in this study, 255 were recruited with 90/255 patients assigned to the IG and 165/255 patients assigned to the CG. During the study, the HQL of the patients in the IG did not change significantly. A significant decrease in the HQL was observed for the CG in 7/8 subscales and in both summary measures of the SF-36. After 12 months, 85.3% of the patients in the IG and 86.3% of the patients in the CG were treated with antiplatelet drugs or oral anticoagulants in accordance to treatment guidelines. Patients in the IG were significantly more satisfied with the individualized recommendations of the pharmacists than patients in the CG.


CONCLUSIONS
Our findings indicate that an intensified PC of patients after ischemic stroke by dedicated pharmacists may have a positive impact on HQL and patients' satisfaction. PC in this study had no impact on adherence to secondary prevention medication.
Hohmann
Carina
C
Department of Pharmacy and Patient Counselling, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany. carina.hohmann@klinikum-fulda.de.|Department of Neurology, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany. carina.hohmann@klinikum-fulda.de.
Klotz
Jürgen M
JM
Department of Neurology, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany.
Radziwill
Roland
R
Department of Pharmacy and Patient Counselling, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany.
Jacobs
Andreas H
AH
Department of Neurology, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany.
Kissel
Thomas
T
Department of Pharmaceutical Technology and Biopharmacy, Philipps University of Marburg, Ketzerbach 63, 35037, Marburg, Germany.
D000368:Aged; D002545:Brain Ischemia / Q000523:psychology / Q000628:therapy*; D003157:Community Pharmacy Services / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000592:standards*; D010595:Pharmacists / Q000592:standards; D011788:Quality of Life / Q000523:psychology; D020521:Stroke / Q000523:psychology / Q000628:therapy*