Advice on Stroke Provided by Pharmacies in the United States

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Advice on Stroke Provided by Pharmacies in the United States

Abstract and Introduction

Abstract


Objectives Studies have found that some health lines and physician's offices have provided treatment advice other than "call 9-1-1 for an ambulance" to patients who present with a stroke scenario. We assessed the treatment advice given by selected pharmacies in the United States regarding stroke.

Methods The investigators called 73 randomly selected pharmacies and informed respondents that the caller's mother had experienced stroke-like symptoms several days earlier. Respondents were asked what should be done if the symptoms returned in the future and then debriefed on the deception afterward.

Results Seventy-one of the 73 pharmacies participated and only 20% (95% confidence interval 12–30) of respondents gave the ideal advice "call 9-1-1 for an ambulance."

Conclusions One out of every five pharmacy respondents across the United States recommended advice other than calling emergency medical services for a potential stroke scenario.

Introduction


Despite improvements in acute stroke care and therapeutic interventions, the primary limiting factor of all existing treatments is the narrow treatment window of 3 to 8 hours (depending on the therapeutic option) from onset of stroke symptoms. Unfortunately, the majority of stroke patients arrive at the emergency department (ED) outside this time window, contributing significantly to the fact that only 2% to 6% of eligible stroke patients receive thrombolytics.

Most of this delayed presentation has resulted from lack of awareness of the major stroke signs and symptoms and failure to call 9-1-1 for ambulance transport to a hospital. With regard to the latter, a 2005 study found that if patients had called 9-1-1 initially, thrombolytic administration in ischemic stroke patients with a known time of onset would have increased from 4% to 29%. As such, the triage advice given to potential stroke patients by all parts of the healthcare system is of paramount importance in the care and treatment of this disease.

One previous study examining this issue surveyed health line operators at institutions with academic neurology programs in the United States and found that almost one-fourth advised a hypothetical stroke patient to call his or her primary care doctor's office instead of calling 9-1-1 for immediate ambulance transport to an ED. Another study surveyed primary care physician offices across the United States and found that 29% of receptionists answering patient telephone calls recommended a non-urgent response (schedule an appointment later in the day) for a classic stroke scenario.

A national pharmacy television advertisement cited that the pharmacy often is people's first access to health care and that individuals often call pharmacists for advice before calling their physicians. In addition, Banks et al concluded that "community pharmacies are used as a source of medical advice and treatment," and Gould et al found that older adults valued the advice given by pharmacists to a greater extent than did younger adults. Consequently, we decided to call pharmacies throughout the United States and present respondents with a crescendo transient ischemic attacks scenario and assess the treatment advice provided in a protocol similar to those used to assess health line operators and primary care physician's offices.

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