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

Columbia University

Status: Completed

Conditions: Hypertension; Stroke; Health Care Acceptability

Treatments: Other: Usual care; Other: TASC intervention

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT04640519

UL1TR001873 (U.S. NIH Grant/Contract)

AAAT2612

Details and patient eligibility

About

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.

Full 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.

Enrollment: 50 patients

Sex: All

Ages: 18 to 100 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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50 participants in 2 patient groups

TASC Intervention

Experimental group

Description:

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.

Treatment:

Other: TASC intervention

TASC Control

Active Comparator group

Description:

Usual care patients will be seen by a primary care nurse practitioner and a stroke neurologist.

Treatment:

Other: Usual care