Residents and Fellows Research in Progress
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: Secondary prevention strategies reduce recurrence of acute ischemic stroke (AIS). While hospital quality measures have aimed to enhance prescribing rates for secondary prevention medications including statins and antiplatelets, recent data reveal that only 38% of patients achieve full optimization in terms of dose and duration. Consequently, a qualitative investigation is imperative to comprehensively explore and elucidate provider perspectives, thereby shedding light on previous findings.
Research Question or Hypothesis: What variables influence hospital providers regarding selection of optimal secondary prevention measures for AIS?
Study Design: qualitative analysis, employing in-depth, semi-structured interviews
Methods: Standards for Reporting Qualitative Research (SRQR) were used to develop the primary objectives for categorizing and evaluating themes underlying prescribing patterns. Hospitalists, residents, and attending physicians were invited to participate, and their demographic information recorded. Interview questions were developed and validated using the grounded theory approach, with questions being adjusted iteratively as theme saturation was achieved. The Theoretical Domains Framework was used for theme development.
Results: 22 physicians participated and 13 themes were identified for influences affecting implementation of secondary prevention measures. The discharge process and transitions of care (TOC) emerged as key areas needing attention, with patient education and provider discharge documentation identified as areas for improvement. Unclear diagnosis and guideline complexities make it difficult for providers to standardize therapeutic selections. Limited access to neurology specialists impacted patient treatment decisions, potentially affecting the quality of care and resident education. Most providers called for discharge process standardization and proposed collaboration with clinical pharmacists as a solution.
Conclusion: Providers demonstrated awareness of the latest guideline recommendations regarding secondary prevention medications. However, themes identified in this study demonstrate numerous barriers to implementation which may explain low rates of therapy optimization, suggesting broader process-based issues. Future research may explore pre-discharge reviews by clinical pharmacists and additional initiatives aimed at bridging existing gaps in the management of AIS.
Presenting Author
Jeremy H. Johnson Pharm.D.Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy
Authors
Emily M. Buatois Pharm.D., BCPS
Texas Tech University Health Sciences Center School of Pharmacy
Krystal K. Haase Pharm.D., FCCP, BCPS, BCCCP
Texas Tech University Health Sciences Center School of Pharmacy