Telehealth After Stroke Care: Integrated Multidisciplinary Access to Post-stroke Care

Not Applicable

Completed

Conditions: Hypertension
Stroke
Health Care Acceptability

Interventions: Other: TASC intervention
Other: Usual care

Registration Number: NCT04640519

Lead Sponsor: Columbia University

Brief Summary: The Telehealth After Stroke Care (TASC) trial is a pilot randomized controlled trial. It aims to evaluate the feasibility of a telehealth based model providing multidisciplinary access including nursing, pharmacy and physician care, and obtain preliminary evidence of efficacy of an integrated telehealth approach to blood pressure management after stroke.

Detailed Description: Hypertension is the most modifiable risk factor for recurrent stroke. Blood pressure (BP) reduction is associated with decreased risk of stroke recurrence but remains poorly controlled in most survivors. Minority groups have a higher prevalence of uncontrolled BP and higher rates of stroke. Limited access contributes to challenges in post-stroke care. Telehealth After Stroke Care (TASC) will be a telehealth intervention that integrates remote BP monitoring and telehealth visits to enhance BP control and promote self-efficacy, with a multidisciplinary approach to improve clinical processes and health outcomes. The investigators will assess for feasibility and obtain preliminary evidence of efficacy. Fifty (50) eligible patients will be screened for inclusion prior to hospital discharge and randomized to TASC or usual care. TASC patients will receive a BP monitoring kit and electronic tablet. They will be scheduled with 5 telehealth visits over 3 months, including primary care nurse practitioner, pharmacy at 4 and 8 weeks and stroke neurologist. Usual care patients will be seen by a primary care nurse practitioner at 1-2 weeks and a stroke neurologist at 1 and 3 months. Data will be collected at 0 and 3 months. The primary outcome will be BP control (BP \<140/90 mmHg) at 3 months. The secondary outcome will be self-efficacy in medication adherence and treatment. Interdisciplinary team competency, fidelity, and telehealth satisfaction surveys will be administered. Patient reported outcomes including depression, cognitive function, and socioeconomic determinants will also be collected. Integrated team-based interventions are needed to improve BP control and reduce racial disparities in post-stroke care. It may be feasible and effective in enhancing post-stroke BP control and promoting self-efficacy.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 50

Inclusion Criteria

Presence of hypertension (by clinical history or hospital BP ≥140/90 on two occasions)
Plan for discharge home after stroke
Ability to provide consent (patient or caregiver)

Exclusion Criteria

Modified Rankin scale ≥ 4 at time of enrollment (severely disabled)
Pregnancy
Severe psychiatric illness
Dialysis or diagnosis of end stage renal disease
Life expectancy < 1 year or terminal illness
Symptomatic flow limiting cerebrovascular stenosis without plan for intervention, or long-term BP goal ≥ 140/90

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
TASC Intervention	TASC intervention	TASC patients will receive a BP monitoring kit and electronic tablet and tailored infographics, and attend 5 telehealth visits over 3 months, including primary care nurse practitioner, pharmacy and stroke neurologist.
TASC Control	Usual care	Usual care patients will be seen by a primary care nurse practitioner and a stroke neurologist.

Primary Outcome Measures

Name	Time	Method
Percentage of Participants With Systolic BP Control	Up to 3 months	The outcome of BP control will be defined by change in mean awake systolic blood pressure from baseline at the time of discharge through remote monitoring at 3 months to be \< 130 mmHg. BP control will be determined by the mean 24-hr blood pressure through remote monitoring at 3 months and survey patient reported outcomes for all participants.
Percentage of Participants Who Completed at Least 1 Video Visit	3 months	This measures the feasibility of the TASC model, the interdisciplinary team competency, fidelity of implementation.

Secondary Outcome Measures

Name	Time	Method
Medication Adherence Percentage	3 months	Feasibility as assessed by patient reported outcomes of self-efficacy in bp medication adherence after study intervention.