Multi-professional post-stroke consultation: What role for the pharmacist?

Abstract

In France, following the instruction DGOS/R4 no. 2015-262 relating to the organization of multi-professional consultations after stroke, consultations involving a neuropsychologist, a specialist of physical and rehabilitation medicine and a pharmacist have been set up on our establishment. Is the choice of a pharmaceutical intervention justified? Its relevance was evaluated through the activity report at 22 months. For each consultations, the pharmacist collects the treatments prescribed and their knowledge (names, indications, time of taking - (qualitative scale at 3 degrees)), the side effects and the adherence score (MORISKI to 4 items). Self-medication, use of tools to help compliance and knowledge of hygiene and dietary rules are also collected. Hundred and eleven patients were received in consultation (cancellation rate 22%) equating to 8 consultations per month of 30 minutes. The average age was 52 years old. The average time between stroke and consultation was 5 ± 3 months. The patients had an average of 4.9 lines of medication; 80% had at least one platelet antiaggregant, 23% an oral anticoagulant, 66% a statin and 59% an antihypertensive drug. Associated treatments were prescribed in 92% of cases and 1/3 used self-medication. 44% of patients reported side effects. Mediocre or mean compliance was found in 24% of patients (MORISKI score ≤ 2) unrelated to patient treatment knowledge (at risk α = 0.05)—the latter were considered to be total in 69% of patients. Finally, 21% used a pillbox and 72% knew hygiene and dietary rules. The role of the pharmacist is essential in view of the number of patients with low medication compliance or poor knowledge. A national multi-center study to measure the impact of enhanced pharmaceutical support on adherence to treatment of stroke patients is underway (ADMED-AVC study) and and will reinforce its position.