Telehealth After Stroke Care: Integrated Multidisciplinary Access to Post-stroke Care
Condition: Stroke; Health Care Acceptability; Hypertension
MeSH terms: Stroke
Study type: Interventional

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.
    

Intervention name(s): Usual care; TASC intervention
Intervention type(s): Other; Other
Intervention description(s): Usual care patients will be seen by a primary care nurse practitioner and a stroke neurologist.; TASC patients will receive a BP monitoring kit and electronic tablet with patient tailored BP infographics. They will be scheduled with 5 telehealth visits over 3 months, including primary care nurse practitioner, pharmacy and stroke neurologist.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Multidisciplinary Team Nursing: transitions of care, motivational interview w/ tailored infographics
Pharmacy: medication education, adherence and titration
Physician: patient tailored risk factor control, post stroke complications
Integrated Approach: Home BP monitoring with remote support, Telehealth visits by each discipline, Tailored BP infographics, Patient Reported Outcomes (PROs)
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Telehealth; Blood Pressure (BP)