The Stroke Transitions Education and Prevention (STEP) Clinic is a new type of clinic designed for stroke patients and was established to provide a comprehensive approach to stroke risk factor reduction. The goal of this study will be more effective than usual care at reducing blood pressure in patients with poorly controlled blood pressure after an ischemic or hemorrhagic stroke or transient ischemic attack.
STEP clinic patients will receive personalized goals, instructions to self-monitor, a blood pressure monitor, prescription medications, sleep apnea screening, dietary counseling, and more frequent follow-up if needed. A stroke neurologist will see patients in the usual care group and recommendations will be sent to their primary care providers.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
115
Patients will visit with STEP clinic staff (including a stroke nurse practitioner or stroke doctor) to receive personalized goals, stroke education (including diet and exercise), instructions to self-monitor using blood pressure cuff, and prescription medications Patient will be scheduled for additional clinic follow-up or be contacted for telephone follow-up for management of your blood pressure. Questionnaires will be administered to determine medication adherence and persistence (following instructions for prescribed medication), disability, depression, cognition, self-efficacy, and sleep apnea. The care plan determined by the STEP clinic will be shared with the patient's primary care provider.
Patients will complete questionnaires related to medical history and health behaviors prior to initial visit. After being seen by the stroke neurologist, patients may be scheduled to return to the stroke clinic according the doctor's recommendations. Recommendations for blood pressure and risk factor monitoring will be sent to primary care providers.
University of Texas Health Science Center at Houston
Houston, Texas, United States
Daytime ambulatory systolic blood pressure
Time frame: 6 months
Daytime ambulatory diastolic blood pressure
Time frame: 6 months
Nighttime ambulatory systolic blood pressure
Time frame: 6 months
Nighttime ambulatory diastolic c blood pressure
Time frame: 6 months
Number of patients achieving blood pressure control at 6 months as assessed by ambulatory blood pressure
Time frame: 6 months
Number of patients achieving blood pressure control at 6 months as assessed by automated office blood pressure
Time frame: 6 months
Number of participants who are adherent to blood pressure medications
Time frame: 6 months
Depressive Symptoms as assessed by Patient Health Questionnaire 9
Time frame: 6 months
Number of patient monitoring blood pressure at home
Time frame: 6 months
Satisfaction with Social Roles and activities as measured by NeuroQuality of Life short form
Time frame: 6 months
Satisfactions with stroke clinic as assessed by Consumer Assessment of Healthcare Providers and Systems Survey
Time frame: 6 months
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Self Efficacy as Assessed by Medication Adherence Self-Efficacy Scale
Time frame: 6 months
Number of composite cardiovascular events
cardiac death, myocardial infarction, ischemic stroke, hemorrhagic stroke
Time frame: 6 months