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NeuroLogic - A follow-up to stem strokes
A follow-up to stem strokes
Date: November 1, 2010
About 20 percent to 40 percent of patients who have a first-time stroke will have another within five years. To help reduce that risk, stroke neurologists often spend copious amounts of time with their most complex patients—speaking with them about their personal risk factors, reviewing their images, or consulting with other experts on the stroke team.
However, notes Johns Hopkins Hospital Stroke Center Director Victor Urrutia, it’s the common Joes with the more ordinary risk factors—diabetes, high blood pressure or obesity, for example—who make up the majority of repeat stroke cases. Most of those patients are seen for only a brief follow-up visit, or don’t come back to the same facility for additional medical care for their stroke.
“By virtue of the way we usually practice medicine, a patient with a complicated condition demands more time from us face to face, but the run-of-the-mill patient is relegated to 15 minutes,” Urrutia says. “That patient’s case may be ‘simple,’ but he has chronic problems that could really benefit from a bigger time investment from his care team.”
Seeing an opportunity to change this paradigm, Urrutia and Stroke Center coordinator and nurse practitioner Brenda Johnson started the Stroke Prevention Clinic to devote more resources to reduce the risk of having a second stroke.
Patients who come to Johns Hopkins for treatment of a stroke or transient ischemic attack are given an appointment to return for an in-depth follow-up appointment. At these appointments, always scheduled on Wednesday mornings, Johnson gives each patient a medical checkup, provides a detailed assessment of the patient’s stroke risk factors and discusses some strategies to reduce that risk.
Spending extra time with these patients after their stroke has several advantages, Johnson notes. Follow-up appointments allow her to get to know patients better, which helps them to feel comfortable opening up about lifestyle factors that could boost their stroke risk.
Patients also often bring family members with them to the appointment. Since they may share similar risk factors, these relatives may also benefit from stroke-prevention education. They can also provide additional support for patients.
“Companions who come with our patients to appointments can really help us with compliance,” Johnson says.
The clinic’s model of care also has benefits for physician-researchers, notes Urrutia. Staying in touch with this population of patients provides him and other doctors a pool of patients who may want to participate in clinical trials and data that they can query for future studies.
“For many patients, stroke is a chronic disease that needs to be approached the way we treat diabetes or cystic fibrosis,” Urrutia says. “The goal here is to give better care for our patients.”
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