To assess clinic follow-up adherence among stroke patients before and after implementation of a dedicated stroke prevention clinic.

Stroke prevention clinics allow for longitudinal care to monitor for stroke recurrence, manage risk factors, and assess barriers to medication adherence. We have previously reported poor clinic adherence rates in traditional follow-up models.

Patients with discharge diagnoses of acute ischemic stroke, intracerebral hemorrhage, or transient ischemic attack were identified in a prospective comprehensive stroke center registry.  We excluded patients who were not scheduled for a follow-up appointment or who died before their clinic appointment.  We collected demographics, socioeconomic factors, length of stay (LOS), geographic factors, stroke characteristics, and adherence to clinic appointments. These variables were examined before and after implementation of a dedicated post-stroke hospitalization clinic.

We identified 274 patients before and 157 patients after implementation of the dedicated clinic (DC).  Demographics, clinic distance, and median LOS were matched between the two cohorts, as were clinical features including medical comorbidities, NIHSS, and discharge modified rankin scale.  IV-tPA utilization was similar although DC patients were more often treated with endovascular therapies.  Discharge disposition was similar (79 vs 82% discharged to home or inpatient rehabilitation).  In the traditional model, 33% of patients arrived to clinic follow-up (median 193 days from hospitalization).  In the DC model, 59% of patients arrived, with a median time to follow-up of 53 days.

In this sample of stroke patients at a tertiary stroke center, we found poor rates of clinic adherence in a traditional follow-up model.  By implementing a dedicated process for post-hospitalization follow-up, we were able to nearly double adherence rates and decrease median length of time to follow-up.  Future work is needed to assess the effects of improved post-hospitalization processes on long term outcomes and medication adherence.