ABSTRACT
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.
