TORONTO — Pharmacists have the education and know-how to look after patients and now a new Canadian study suggests that they can successfully manage the health of stroke survivors.
As health care demands tighten up on doctors, Canadian researchers are looking at ways to shift responsibility to other frontline health care workers who are ready to provide an extra set of eyes on patient health care.
Last August, for example, some provinces handed more autonomy to pharmacists who are now allowed to prescribe or take away medication, order and interpret tests and even vaccinate patients.
When Dr. Finlay McAlister first heard of this news, he sought out to research the implications on stroke survivors and how pharmacists counsel them back to better health. Turns out, they’re pretty successful.
“It wouldn’t replace primary care,” McAlister told Global News. McAlister is a general medicine doctor and scientist at the University of Alberta.
“Having a multi-disciplinary team involved with the patient is key to improving outcomes so part of that team is the physician, part of that team is also the pharmacist, dietitian and nurses, all with expertise. It’s a team-based approach that would optimize outcomes,” he said.
His study, published Monday in the Canadian Medical Association Journal, had a group of pharmacists and a group of nurses look after the welfare of 279 Edmonton stroke patients over the course of six months across three hospitals.
The first year post-stroke is critical: if someone has a minor stroke, it’s typically a warning sign. One quarter will have a major stroke or heart attack within the next 12 months. What’s key in the subsequent months after the initial incident is to lower risk factors.
At the start of the study, none of the participants had blood pressure or cholesterol levels that met the recommended targets set by Canadian stroke guidelines.
Both the nurses and pharmacists coached participants on diet, smoking, exercise and other lifestyle factors. They also acted as “case managers,” measuring blood pressure and bad cholesterol levels, then offering those summaries to patients’ doctors.
At the half-year mark, the nurses documented a 30 per cent improvement in health in the patients they looked after. The pharmacists had a 43 per cent improvement in their patients.
Pharmacists also fared much better in lowering LDL cholesterol (51 per cent) compared to nurses (34 per cent).
Right now, neurologists and other specialists see stroke patients before they’re handed off to their doctors to look after them in the long run.
The difference between nurses and pharmacists is that the latter has the authority to adjust medication to get the best results while nurses would have to relay their findings to the doctor to sign off on directions to a pharmacist. That would mean “cutting out the middle man,” which is pivotal to a time-strapped health care system, according to McAlister.
“There are just not enough primary care physicians and specialists to handle the increasing volume of patients. The population is aging, we have more chronic diseases, a lot more people survive heart attack and stroke,” McAlister said.
“So we have a larger at-risk population and a shrinking number of physicians who can deal with it. But we have a lot of trained health care providers who are not optimally used at this time,” he said.
The nurses and pharmacists received basic training, but they were already well-versed in cardiovascular health, treatment guidelines and patient education.
McAlister’s hope is that this multi-disciplinary approach will be taken to care for other at-risk groups, such as people who have survived a heart attack. Then, patients with chronic diseases, such as diabetes and hypertension, could receive care from doctors, nurses and pharmacists.
“In medicine, we work in silos, but if we can get everybody working together for these higher risk patients, we’ll see more benefits,” McAlister said.