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A prescription for better stroke care


Stroke patients are 70 per cent more likely to continue taking their stroke prevention medications one year later if they have a prescription in hand when discharged – according to researchers at St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES).

Using data from 11 stroke centres, researchers determined how many Ontarians were taking their medications one week, one year and two years after having a stroke. The results reveal the importance of simple interventions, such as giving a prescription to a patient before discharge, to increase short- and long-term stroke prevention.

“The good news is that Ontarians are receiving very good stroke care overall,” said Dr. Gustavo Saposnik, lead author of the study and director of the Stroke Research Unit of St. Michael's Hospital. “But there are still things we can do to help patients receive better quality, long-term care after a stroke. And the first thing on that list is giving each patient a prescription before he or she leaves as part of discharge planning.”

According to the Heart and Stroke Foundation, there are an estimated 50,000 strokes in Canada each year. After having a stroke or minor stroke, the risk of having another stroke is greater. The risk of recurrence, however, can be reduced by more than 80 per cent by following stroke prevention strategies such as rehabilitation and taking medications.

Dr. Saposnik said that at the time of discharge most patients are more focused on the tangible issues of their recovery, such as: “What will happen at rehab?” or “What will happen when I go home?”

“Patients have other things on their minds after a stroke and it’s up to us to give them the tools they need to thrive,” said Dr. Saposnik, who is also an adjunct scientist at ICES.

The two types of drugs most commonly prescribed after a stroke are antihypertensives (to lower blood pressure) and statins (to lower blood cholesterol). Patients may be prescribed one of these drugs or both. Patients may remain on these drugs for the rest of their lives to prevent another stroke. About 315,000 Canadians are living with the effects of stroke.

Stroke patients who had been given a prescription before discharge were 70 per cent more likely than other patients to still be taking both antihypertensives and statins one year later and 40 per cent more likely after two years.

There are several reasons why a patient might be discharged before receiving a prescription. Doctors may assume their patient will receive a prescription from a family doctor, whom patients are supposed to see within seven days of discharge. Another reason some patients leave without a prescription is that the prescription might be dictated in the chart but not actually delivered to patients.

This study was supported in part by the Ontario Stroke Network, the Heart and Stroke Foundation of Canada and the Ontario Ministry of Health and Long-Term Care.

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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