title: Case management for blood pressure and lipid level control after minor stroke: PREVENTION randomized controlled trial.
abstract: BACKGROUND
  Optimization of systolic blood pressure and lipid levels are essential for secondary prevention after ischemic stroke, but there are substantial gaps in care, which could be addressed by nurse- or pharmacist-led care. We compared 2 types of case management (active prescribing by pharmacists or nurse-led screening and feedback to primary care physicians) in addition to usual care.
  
  
  METHODS
  We performed a prospective randomized controlled trial involving adults with recent minor ischemic stroke or transient ischemic attack whose systolic blood pressure or lipid levels were above guideline targets. Participants in both groups had a monthly visit for 6 months with either a nurse or pharmacist. Nurses measured cardiovascular risk factors, counselled patients and faxed results to primary care physicians (active control). Pharmacists did all of the above as well as prescribed according to treatment algorithms (intervention).
  
  
  RESULTS
  Most of the 279 study participants (mean age 67.6 yr, mean systolic blood pressure 134 mm Hg, mean low-density lipoprotein [LDL] cholesterol 3.23 mmol/L) were already receiving treatment at baseline (antihypertensives: 78.1%; statins: 84.6%), but none met guideline targets (systolic blood pressure ≤ 140 mm Hg, fasting LDL cholesterol ≤ 2.0 mmol/L). Substantial improvements were observed in both groups after 6 months: 43.4% of participants in the pharmacist case manager group met both systolic blood pressure and LDL guideline targets compared with 30.9% in the nurse-led group (12.5% absolute difference; number needed to treat = 8, p = 0.03).
  
  
  CONCLUSIONS
  Compared with nurse-led case management (risk factor evaluation, counselling and feedback to primary care providers), active case management by pharmacists substantially improved risk factor control at 6 months among patients who had experienced a stroke.
  
  
  BACKGROUND
  ClinicalTrials.gov, no. NCT00931788.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Raj S
authors.initials: RS
authors.lastname: Padwal
authors.forename: Miriam
authors.initials: M
authors.lastname: Fradette
authors.forename: Ann
authors.initials: A
authors.lastname: Thompson
authors.forename: Brian
authors.initials: B
authors.lastname: Buck
authors.forename: Naeem
authors.initials: N
authors.lastname: Dean
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bakal
authors.forename: Ross
authors.initials: R
authors.lastname: Tsuyuki
authors.forename: Steven
authors.initials: S
authors.lastname: Grover
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019090:Case Management; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy / Q000517:prevention & control*; D006973:Hypertension / Q000188:drug therapy / Q000517:prevention & control*; D002546:Ischemic Attack, Transient / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011315:Preventive Medicine / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D008078:Cholesterol, LDL
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