The purpose of this study is to examine the impact of a multidisciplinary telehealth-based model of outpatient stroke care on blood pressure control following stroke, and further, to evaluate its impact on racial disparities in post-stroke blood pressure control.
Blood pressure is poorly controlled for many stroke survivors and racial disparities in blood pressure control and stroke recurrence exist. The purpose of this study is to examine the impact of a multidisciplinary, telehealth based, outpatient model of care on outcomes after stroke with a focus on blood pressure control. The Video-based Intervention to Reduce Treatment and Outcome Disparities in Adults Livings with Stroke and Transient Ischemic Attack (VIRTUAL) has several components including early follow-up via telehealth with a multidisciplinary team, remote blood pressure monitoring, and medication adjustment by a pharmacist.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
542
At the time of discharge, stroke survivors in the VIRTUAL arm will receive a package containing an iPad and a remote BP monitoring device that allows transmission of BP to the study team.The first telehealth visit will occur 7-14 days after discharge. Patient will be counseled on the importance of BP monitoring, salt reduction, and the importance of diet and exercise for stroke prevention. Medications, side effects and interactions will be reviewed. The social worker will refer the patient to specific resources according to social needs abd patient will be referred to a primary care provider if they do not have one. Subsequent video visits will be 1-month (30 days +/- 7) , 3 months (90 days +/- 14), and 5 months (150 days +/- 14) days after enrollment.
Participants randomized to standard care will receive an educational packet and a blood pressure monitor prior to hospital discharge. They will be contacted by a social worker to determine if they received their medications and appointments. The stroke practitioner will evaluate the patients at 7-14 days and then follow up according to current standard of care. They will be seen over video or in-person, according to their preference and capabilities. The pharmacist will contact patients at 1-month (30 +/- 7 days) days over the telephone to review BP logs and will make recommendations to their primary care provider to adjust BP medications. Subsequent pharmacist calls will occur monthly until 6 months and recommendations for medication adjustments will be communicated to their primary care provider.
The University of Texas Health Science Center at Houston
Houston, Texas, United States
6 month blood pressure control (24-hour ambulatory)
Proportion of participants with controlled BP according to 24- hour ambulatory BP (\<125/75 mmHg)
Time frame: 6 months after discharge
12 month blood pressure control (24-hour ambulatory)
Proportion of participants with controlled BP according to 24- hour ambulatory BP (\<125/75 mmHg)
Time frame: 12 months after discharge
Composite Recurrent Vascular Events
Number of patients with myocardial infarction, ischemic or hemorrhagic stroke, coronary revascularization, acute cardiac death, and heart failure hospitalization)
Time frame: 12 months after discharge
Proportion of uninsured who obtain insurance
Proportion of uninsured patients who obtain insurance
Time frame: 3 months after hospital discharge
Proportion of uninsured who obtain insurance
Proportion of uninsured patients who obtain insurance
Time frame: 6 months after hospital discharge
Acute healthcare utilization
Number of hospital readmissions, emergency department (ED) visits, and urgent care visits
Time frame: 3 months after hospital discharge
Acute healthcare utilization
Number of hospital readmissions, ED visits, and urgent care visits
Time frame: 6 months after hospital discharge
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Acute healthcare utilization
Number of hospital readmissions, ED visits, and urgent care visits
Time frame: 12 months after hospital discharge