January 27, 2025 • 26 mins
Stay ahead in stroke prevention with insights from the updated AHA/ASA guidelines, designed to optimize care for at-risk patients. This episode highlights key changes, actionable strategies, and the pharmacist’s role in reducing stroke incidence through evidence-based interventions. Tune in to stay informed and enhance patient outcomes in stroke prevention.
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Justinne Guyton, PharmD, BCACP
Associate Professor of Pharmacy Practice
University of Health Sciences and Pharmacy
Reference
2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association
https://www.ahajournals.org/doi/10.1161/STR.0000000000000475
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify three key updates in the AHA/ASA 2024 Stroke Prevention Guideline.
2. Explain the pharmacists role in applying evidence-based strategies for stroke prevention.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-022-H01-P
Initial release date: 1/27/2025
Expiration date: 1/27/2026
Additional CPE details can be found here.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Hey CE Impact subscribers.
Welcome to the Game ChangersClinical Conversations podcast.
I'm your host, Josh Kinsey, andas always, I'm super excited
about our conversation today.
Stroke remains one of theleading causes of death and
disability.
The new AHA-ASA StrokePrevention Guideline provides
critical updates to enhanceprevention efforts.
Today, we'll explore these keyupdates and discuss how
(00:30):
pharmacists can play a pivotalrole in implementing
evidence-based stroke preventionpractices.
It's so great to have JustineGuyton as our guest expert for
this episode.
Welcome, Justine.
Thanks for joining us.
Speaker 2 (00:39):
Thanks so much for having me.
Speaker 1 (00:40):
Yeah, so before we jump in, in case our learners
are not familiar with you, giveus a little bit about your
background, maybe a little bitabout your practice site and why
you're passionate about thistopic today.
Speaker 2 (00:52):
Yeah, thank you.
So I practice in ambulatorycare, so I am in a primary care
clinic at a department of publichealth, so I get to work with a
lot of patients that areunderinsured and have a lot of
different factors impactingtheir access to healthcare.
So it's a really kind ofinteresting place to be a
pharmacist trying to applyguidelines, kind of, with
(01:12):
another layer of patient care inthere.
Speaker 1 (01:15):
Yeah, that's great, that's awesome.
Yeah, I appreciate your servicein that realm and also again
appreciate you joining us today.
So, thank you.
Let's jump into just kind oflaying I always like to lay the
groundwork.
My listeners have gotten usedto me kind of making sure the
foundation is laying.
We're all on the same pagebefore we start talking.
So just again, review for usthe prevalence of stroke, like
(01:37):
how impactful is it on publichealth?
It's probably more common thanwe realize.
So let's just kind of lay thatfield first and talk a little
bit about the prevalence ofstroke and maybe you know like
the history of the guidelinesand where they came from and
that kind of thing.
Speaker 2 (01:52):
Yeah, so just wanted to reiterate these guidelines
are the primary preventionguidelines.
So the whole kind of focus ofthese guidelines is about
preventing stroke, preventing afirst stroke.
So there's going to be adifferent set of guidelines for
patients that have already had astroke.
So really prevention is kind ofthe key word in this
conversation.
Today.
There's hundreds of thousandsof patients that are having a
(02:13):
first stroke each year and Ieven heard a stat that at least
half of those are thought to bepreventable.
So I think that's really kindof the impetus for this
guideline is just how impactfulstroke can be with morbidity,
mortality and kind of likeimpact on somebody's life.
And then knowing that half ofthose could have been prevented.
It's obviously really importantthat we have recommendations
(02:33):
that are available to helppeople kind of understand how to
prevent them.
Speaker 1 (02:37):
Wow, yeah, yeah, that's a wild stat to know that
so many could have beenprevented.
So, again, it's why educationis key and that we're making
sure that our pharmacists outthere are on the front lines
trying to prevent these.
So you mentioned the strokeprevention guidelines and tell
(02:58):
us about the significance ofthem.
You and I talked previously andyou reminded me that they only
come out once every 10 years orso, so clearly this is a big
deal that we're talking aboutthe updates.
So maybe what informs thoseupdates?
And just a little history aboutthe guidelines in general.
Speaker 2 (03:14):
Yeah, so you're right , this is the first time these
prevention guidelines have beenupdated in 10 years, so
obviously there's been a lot ofinformation that's come out in
the meantime, so that's a bigimpetus for this change.
I'd say, when I was lookingthrough the guidelines I saw
kind of two big areas that Ithink are noteworthy.
So one I think one of the waysthat they kind of really focus
the guidelines and are kind ofdiscussing them, if you will,
(03:37):
has been kind of simplified.
So there's a term called AHA,so American Heart Association's
Life's Essential Eight, and sothat's kind of a new way of
thinking about, or maybeorganizing it in your brain, a
lot of these things that we'lltalk about as far as what the
recommendations are.
And then I think the other bigthing that I noticed was a
couple new risk factors had beenidentified maybe in the past 10
years and had been included inthese guidelines.
(03:59):
So those are kind of the twobig areas that I saw being
updated.
Speaker 1 (04:02):
Yeah, and that's a key one in my opinion the risk
factors, because again, that'ssomething else for us to be on
the lookout for, since we areoften the first and most common
healthcare provider that ourpatients see.
(04:22):
Because you know it's often thatthey see us, and opposed to an
annual physical or whatnot.
So right, yeah, okay, that'sgreat.
So let's jump into a little bitabout what are some of the
opportunities.
So we always like to try toprovide our listeners and our
learners with opportunities thatthey can employ at their
practice site.
So what can we do aspharmacists?
How can we expand our roles?
What are some of the areas andthings that we can do to help
prevent strokes?
Speaker 2 (04:43):
Yeah.
So I think, kind of thinkingabout this, there's just so many
ways I could I could tacklethis question, or pharmacists
could be involved, going back tothe AHA like life's essential
aid it's really the AmericanHeart Association kind of
discussing eight differentfacets of like everyday life
that we should be payingattention to.
That impact stroke.
So that, right, there is eightdifferent ways.
(05:03):
So those areas are going to beblood sugar, blood pressure,
weight management, lifestyle.
So food choices, exercisechoices, sleep a lot of
different areas, and so thoseare all smoking cessation, so
those are all the different waysthat we know somebody is going
to be.
Day-to-day life, lifestyle orrisk factors are implementing or
(05:24):
impacting their stroke risk.
So simple things.
I mean, I don't know how manypatients fully realize that
their blood pressure needs to becontrolled, not just for the
sake of the number of theirblood pressure, but what that
blood pressure has an effect on,so things like increasing
stroke risk.
So I think people know ifstroke is bad, want to get my
blood pressure controlled, butthey don't necessarily always
(05:45):
connect those and so just evenletting patients know why it's
important that they take theirblood pressure medicines every
day, not just to get that numberdown, even if they feel okay,
but because that's impactingtheir stroke risk.
It's kind of one way that Ithink about that.
Speaker 1 (05:59):
Yeah, absolutely so.
Adherence is key formedications that your patients
are already taking.
So, again, that would be alight bulb for you as a
pharmacist when you see apatient who is on a blood
pressure medication.
Okay, this is a patient who isat risk for stroke.
Speaker 2 (06:16):
And so that's where I need to be preventing.
Speaker 1 (06:18):
So, again, educating the patient that adherence is
key, making sure that they Ilove your comment of take it,
even if you feel.
Well, you know, because it's somany, so many patients that
just, oh, I felt I felt finethis morning.
I didn't feel like my bloodpressure was high or my sugar
was fine this morning orwhatever.
Well, it probably is becauseyou've been taking your medicine
(06:39):
, so let's continue, you know.
But yeah, so that's that'sreally important as well.
What are some of the other?
So you mentioned glucosecontrol and weight management.
So, like, what are some of thethings that we can look for?
Obviously, we can look for apatient who's on a diabetic
medication diabetes medication.
But like, what are some of theother things that we can kind of
(07:01):
just keep our eyes open for andbe like, oh, that's an at-risk
patient for a stroke?
Yeah.
Speaker 2 (07:06):
Yeah, so you're right , diabetes is one.
Another one that maybe wouldtake a little bit more digging
would be looking at patients tosee if they're candidates for
cholesterol medicine so statinsessentially.
So we know that increasedcholesterol, especially LDL,
increases stroke risk.
Many different sets ofguidelines are going to assess
patients and their statin riskand if they would benefit from a
(07:27):
statin.
And we definitely know thatthose high risk patients so the
really high LDL is like 190 andabove or when we use the 10-year
ASCVD risk calculator ifanybody has that app it's what I
often use to calculate itreally fast but those with
elevated risk or elevated riskand risk factors are going to be
patients that need to be on astatin and kind of like blood
pressure, but maybe a little bitdifferent.
I think cholesterol is evenmore confusing for patients
(07:50):
because sometimes like theirnumber looks OK but really we're
looking kind of more globallywith those risk factors and what
that percent 10 year risk is todetermine if they benefit from
the statin.
And so I think that one doesn'talways like strike patients as
like why they need to takecholesterol medicine, or if
they're even a candidate for one.
Speaker 1 (08:07):
The guidelines are pretty straightforward about who
should be initiated on one, soI think that's another one that
if you have access to checkinglipids, you'll be able to
determine if a patient wouldbenefit from the statin pretty
quickly, yeah, and I know fromexperience I'm assuming it still
is the case but a lot of MTMopportunities are out there
about statins and making surethat everyone is available.
(08:29):
Everyone that's eligible for astatin has at least been
introduced to it or it's beendiscussed with them.
So, yeah, that's a great callout as well, somewhere that we
can start with prevention.
And you mentioned weight andexercise.
So let's talk a little bitabout those, how they impact and
maybe how, as a pharmacist, wecan kind of call those out too.
Speaker 2 (08:48):
Yeah, I think big picture, the lifestyle
recommendations that are inthese guidelines are for
prevention.
So if you're thinking about itfrom that perspective, they're
really recommendations foreverybody.
I try to remind my patients ofthat.
This is not just for youbecause you have diabetes or
because you have a stroke risk.
Really it's for everybody forrisk reduction.
(09:12):
So exercise recommendations are150 minutes of moderate
intensity activity, which mightnot really sound very specific,
but that's kind of a brisk walkwhere you're kind of walking
pretty quickly, you can stilltalk and everything, but you're
putting some effort into it.
Um, or 75 minutes of, uh,vigorous activity in a week.
So that'd be something likejogging or anything more intense
than that.
But those recommendations arereally for everybody and so
(09:34):
that's something that any youcould talk to any adult about in
terms of like lifestyle, likefood intake.
Um, one of the bigrecommendations for many
different prevention guidelinesis the Mediterranean style of
diet.
Speaker 1 (09:47):
Got it, Got it.
That's great, Super helpful.
So what are the guidelines?
Again, their prevention.
So is there anything that weneed to be like integrating or
implementing into, or is it?
Or is it strictly just becausetheir prevention and pretty much
(10:09):
all of our patients are goingto have one of those things?
If your patient is in yourpharmacy, they're probably there
for blood pressure, diabetes,obesity, you know they're
probably there for somethingright?
So is there any other thingthat we need to kind of keep in
mind as far as, like picking outwho we should be targeting to
talk to about the preventivetherapies, or have we covered
(10:29):
all you think?
Speaker 2 (10:30):
I really think that you know everybody should be
having these conversations.
I think that's a big part ofthe push of the guidelines is
making sure that patientsunderstand their risk factors
factors so not every single oneof them can be fixed, but
patients can understand kind ofwhat their baseline risk is and
that they are at risk for astroke and why maybe some of the
things that are modifiable areimportant.
So I do think that theconversation is worthwhile.
(10:53):
In adults, obviously there'ssome patients that might have a
bigger magnitude of benefit thanothers.
But I think that this issomething that you can pick
maybe one or two of those life'sessential eights and see if
that doesn't like make moresense for you to implement into
your practice.
I definitely can agree thattalking to every patient about
eight different factors ofchange could be really
(11:13):
cumbersome.
Take your whole day.
You know not leave a lot oftime for other things, but maybe
picking like one or two.
That makes sense for your site.
Speaker 1 (11:21):
Yeah, that's great and I love that you called out
to the modifiable ones.
I think that that's reallyimportant to kind of explain to
patients and, in a sense of like, here's what I mean.
Here's what we mean bymodifiable.
It's things that you canactually proactively make a
change for.
So yeah that's key.
Um, okay, great, so let's moveinto then some of the challenges
(11:42):
.
So we talked you briefly, justtouched on a challenge, which is
time.
Right In the pharmacy practicesetting.
We all know that if we couldall wish for one thing, it would
be more time or more assistance, more staff to help with that.
Give us more time.
So obviously that's a barrier.
What are some of the otherchallenges and barriers that you
think are going to impede usfrom helping to carry out and to
(12:08):
kind of target these patientsand kind of implement the
guidelines along the way, likeyou mentioned?
Speaker 2 (12:14):
Yeah, I mean, you're definitely right, time is going
to be a challenge.
So I think that, like kind ofstarting strategically and
figuring out maybe who yourhighest risk patients are you
know, looking by blood pressuremedicine or statin or whatever
it might be might be a way tokind of target that.
I think the other thing thatcan be a challenge is making
sure that pharmacists have somesort of way to implement change.
So ideally, you know, we wouldidentify a change that needs to
(12:38):
be made and also be able toimplement that, whether it's
through an MTM or having arelationship with a provider or
some sort of useful way to kindof contact a prescribing
healthcare provider.
If you're not able to do, thatare going to be some of the ways
to be able to have a big impact.
If you're kind of in thecommunity setting, yeah, that's
great a big impact if you'rekind of in the community setting
.
Speaker 1 (12:58):
Yeah, that's great.
A lot of patients who as we'vetouched on, a lot of patients
who are at risk for a stroke,have a lot of comorbid
conditions, so they're going tobe complex patients.
What are some of the other keythings that we can attack with
(13:18):
these patients?
What are some of the thingsthat we can spend time on and
that we can put our effort into?
Speaker 2 (13:23):
Yeah, the way that I like to approach that is kind of
almost from the flip side ofI'll often talk to patients
about.
Like you know, there's lots ofrecommendations in this area,
this area and this area.
Is there something that you'vebeen thinking about that you'd
like more information on, or isthere one of these areas that
you're interested in targetingthat I can kind of help you make
a specific plan with and I'llkind of try to work with where
they already kind of maybe havethat intrinsic motivation and
(13:45):
they're maybe excited aboutsomething or had been thinking
about something?
and try to run with that first,versus coming at a patient, kind
of cold, saying you really needto quit smoking, you know, and
that's just not what they'reready to do, but maybe they are
willing to, you know, work ontheir diet and change something
different about the way thatthey're eating and their eating
habits yeah, absolutely,absolutely.
Speaker 1 (14:04):
what are some of the opportunities for us as um
healthcare providers?
Are there any opportunities forus to collaborate with other
healthcare providers, like whatyou?
You mentioned weight nutrition,so that kind of made me think
about that.
Is there anybody else that wecould be collaborating with and
to make sure that our patientshave access to everything they
(14:27):
need?
Speaker 2 (14:27):
Yeah, I think it really just depends on the
patient.
But you're right, there aresome patients who would benefit
from a little bit of lifestyleeducation and like what a
Mediterranean diet is, but somethat would really benefit from
and are eager to learn more andmight having a relationship with
a nutritionist might be thebest thing for them.
Same thing with physicaltherapy.
I've definitely have somepatients that maybe have a bad
(14:49):
back or a bad knee or somethingand they want to exercise or get
more active and get moremovement into their life.
But they're really just notsure how.
Those are great kind of sparksto kind of like be able to refer
out or have them talk to theirprovider about getting a
referral to something likephysical therapy and thinking
about what would be safe andeffective movement for them,
kind of in the place thatthey're at.
Speaker 1 (15:09):
Yeah, that's good, that's great.
So you had mentioned, obviously, your background in the public
health kind of sector and youhave a lot of patients who are
underinsured and don't havegreat access to care, so let's
talk about that.
That's obviously a challenge aswell.
What?
are some of the tips and tricksyou can share with our listeners
about ways to overcome theaccess to care, the cost of
(15:31):
medications.
We all know that both of thosethings can affect adherence in
patients, and if a patient hasbad blood pressure and they're
not adhering on their med, thenthey're at risk for you know.
So like it all boils down, itboils back to this.
So anything you can kind ofshare with us there that you've
learned in your.
Speaker 2 (15:49):
yeah, this might be kind of old news to some people,
but kind of the things that Ithink about is just any of the
generic combination medicineswhere I can lower the copay by
just having one copay instead oftwo is something I jump to kind
of right away.
We use a lot of copay cards forbrand name medicines, trying to
(16:09):
get them down a little bit forpatients, especially beginning
of the year, if they have highercopays or if their insurance
has them at the higher tier.
We use things like, even likeGoodRx, just to look quickly at
different pharmacies, at whatmaybe a comparison might be for
the cash price of a medicationat a couple different places.
And then we have enoughpatients that don't have any
(16:29):
insurance at all that we dopretty routinely use the
manufacturer's coupons, so kindof the patient assistance
programs through themanufacturers directly.
That's definitely a morecumbersome process.
It includes, you know, theprovider, the prescriber's
signature, the patient'ssignature, their financial
information.
But for some people you knowit's a really necessary step for
(16:52):
them and they're willing to dothe work of bringing it back.
Yeah.
Speaker 1 (16:55):
Yeah, and because it could be game changing for
especially if it's, you know, ifthey failed on other therapies
and this is the one thatactually is finally working and
you know they're willing to gothrough that.
So, and you know one thing thatyou mentioned there even you
didn't mention it, but I'llthrow it in.
You kind of touched on it.
You know we have training forcommunity health workers.
Know we have training forcommunity health workers.
(17:20):
Yeah, they are really trainingtechnicians in that space to be
kind of the right hand.
They're already the right handpeople in our pharmacies and so
now they're, you know, beingtrained in that public health
space to identify theseopportunities.
And so you'd mentioned thatthat was the work could be
cumbersome sometimes, but, butyou know, if you have a CHW or
if you have a technician, thatwas the work could be cumbersome
sometimes, but but you know, ifyou have a CHW or if you have a
technician that's willing to gothrough that training, that's
(17:43):
also something they can do.
And they can also help identifyother solutions for food
insecurities and transportationinsecurities and other things
that we see.
Because, let's be honest, ifyou have a patient who's
underinsured and they're seeingyou at a clinic.
You know, at a public accessclinic they probably have other
insecurities and issues.
(18:04):
Yeah for sure.
Okay, so let's talk through alittle bit then, too, about I
know myself, as when I practicedit's been a while, but when I
practiced and when I actuallypracticed pharmacy, it was
oftentimes in the communityspace, and so you know we do a
(18:27):
lot of medication dispensing andeducation about things new
medications, making sure they'reinherent and everything but we
don't always get to or do weshould, but we don't always stay
up to date with the guidelines.
So why is it important for allpharmacists to stay up to date
with this?
Why is you know if you can juststress the importance that like
(18:49):
it's impactful and it reallymakes a difference and just kind
of shed?
some light for us.
Speaker 2 (18:55):
Yeah, I would say big picture.
I think cardiovascular healthis definitely one of the ones
that we're just seeing a lot inlive more and more new trials
coming out and data coming outand, obviously, guideline
updates.
So to me it definitely standsout as a space where we're
seeing a lot of change andseeing a lot of data and newer
medications that can be helpful.
Maybe not anything thatspecifically hits like the AHA,
(19:18):
asa, stroke preventionguidelines specifically, but I
think when we think about thatspace, especially with patients
with diabetes, we're definitelyseeing like an explosion of
medication classes that haveglucose lowering benefit and
then the GLPs as a class arelinked to stroke lowering
benefit.
So when I'm talking to patientsabout why I want them to start
an injection for the first time,the fact that I know that it
(19:39):
helps lower their blood sugarsbut it also helps lower their
cardiovascular risk, is aselling point that I can kind of
help them with to betterunderstand why this medicine is
important versus maybeincreasing their metformin dose
today.
Speaker 1 (19:53):
Absolutely.
Yeah, that's important.
So are there any otherchallenges that you've seen with
?
You know, pharmacists on thefront line of trying to
implement these preventionguidelines, anything else that
you can be like, you wouldn't bethe only one.
Here's the way around it.
Anything that we've missedtoday that you want to share?
Speaker 2 (20:17):
I can't think of anything big.
I think probably just like oneof the biggest challenges is
just how many opportunitiesthere are here.
So figuring out, like which oneyou want to do, or all eight of
them, like you know,implementing them into a
practice can be challenging.
Speaker 1 (20:25):
Yeah for sure.
Speaker 2 (20:26):
And then I think, just the time some of these it's
not like as straightforward aslike treatment guidelines are.
So just to kind of flip thatlike if you have a, a stroke and
you go to the hospital, youknow, you know you're getting X,
Y and Z medicine for thatstroke, you know what just
happened, it was uncomfortable,You're probably scared, You're
getting discharged soon and thelength of medication to like
(20:47):
what its goal is, is very clear.
I think when we're talkingabout prevention it becomes a
little bit less clear, it's alittle more nebulous.
It's like, oh, my future selfin five to 10 years.
So anytime that you have arelationship with a patient and
you already know them and youcan kind of explain these things
, I think that it makes it moreimpactful versus just somebody
yakking at you with you shouldlose weight or you should eat
(21:09):
healthy For sure, and connectingthose dots for the patients.
Speaker 1 (21:13):
I think that's a great point.
Like sometimes even with ustelling them like your weight
and you know your weight is afactor in your risk for a stroke
like, but, but why and and?
Okay, so my blood pressure is afactor, but like why and why
(21:33):
does me taking my medicine forblood pressure make that
decrease?
You know, so that risk factordecrease.
So I think it's important,again, connect those dots.
So to me it sounds like one ofour biggest roles as a
pharmacist is education, patienteducation, yeah, and just
making sure that we are up todate on the most important
(21:54):
information so that we can shareit with our patients
appropriately.
Speaker 2 (21:57):
Yeah, and I would also challenge listeners to kind
of think about the fact that Ilike to practice what I preach,
if you will.
So these are things that all ofus should also be doing, and I
think, the more that you kind ofremember that these also apply
to you, you should be thinkingabout these in your own life,
and then I think that makes formore meaningful conversations
with patients when you're likeyeah, I love to eat cookies too.
(22:19):
Like goodness, it's Girl Scoutseason right now and the cookies
are coming out and I'm going tohave a hard time, but what I'm
going to do instead is X, Y or Z, and this is what's helped me.
I think sometimes that can helpyou in practice kind of connect
with patients a little bitbetter and kind of remember this
is really something foreverybody.
Speaker 1 (22:36):
Yeah, that's great.
Well, so, as kind of just likea summary, I just want to
reiterate again because we'vegiven a lot of information out
there for our listeners.
It's not anything new to them.
They're used to me throwingtons of stuff at them, stuff at
them.
So let's just kind of I alwayslike to do a summary and kind of
wrap it back up with, like Ithink and correct me if I'm
(22:58):
wrong but what I'm hearing yousay is pick a few, like there's
no way that we can possibly doeverything that the guidelines
suggest, right, the preventionguidelines.
But to pick a few, and I thinkthat some of that low hanging
fruit is looking for patientswho are on a blood pressure
medication.
I think that some of the thatlow hanging fruit is looking for
patients who are on a bloodpressure medication.
Like that's, that's a first,that's a first step Patients who
(23:18):
are on diabetic medications,patients who we know to be obese
or have struggled with weightor nutrition in the past.
And then you know that can,that can go down many routes,
because that can bring in your,your exercise and all that kind
of stuff as well, um, and reallyfocus on adherence, right.
(23:41):
So that's, that's a key, keyone as well, um, adherence and
education and targeting maybethose patients that we know to
be diagnosed with something orhave a comorbid condition or
something.
Speaker 2 (23:54):
Yeah, yeah, absolutely Okay great, all right
.
Speaker 1 (23:57):
Well, I learned.
I learned stuff as well.
That's great.
Okay, so, like, what I alwayslike to do at the end is give
you a chance to tell us what thegame changer is.
So, summarizing kind ofeverything.
I did a summary here, but, like, what is the game changer?
Why do listeners need to walkaway from this episode and do
(24:17):
this?
Why do they need to implementthis?
Why do they need to targetthose patients?
Speaker 2 (24:21):
So tell us what the game changer is.
I think, if I was going tosummarize, I would just remind
everybody that half of strokesare preventable and there are at
least eight different ways thatwe can help patients reduce
their risk of stroke through theAHA's Life's Essential Eight.
These are things that patientscan do with lifestyle, so
education can be implemented,and then medication and
adherence all play a factor inthat.
(24:43):
So knowing that there is suchroom for improvement in
population health and knowingthat we see patients every day,
it just means that there's somuch room for a pharmacist to be
involved.
Speaker 1 (24:52):
Yeah, that's great, that's great.
I just had this wild thought.
I'm not wild, I'm sure manypeople thought of it before and
they've probably done it butanother way to simply do it,
because you're saying that halfare preventable.
Again, that's such an impactfulstatement.
But even if you did somethingas simple as putting a flyer at
your register if you're in acommunity practice or, you know,
(25:14):
maybe it's a flyer on a standin your waiting area if you're
in an amcare clinic or something, but that saying did you know
that half of all strokes arepreventable, are you at risk?
You know, ask the pharmacistfor more information, or
something.
So I think that, um, justreally kind of putting yourself
out there as that expert, um,because we are and just really
(25:38):
kind of owning that.
So, yeah, okay, great, this wasgreat.
Justine, thank you so much forjoining us today.
I appreciate it.
Speaker 2 (25:44):
Yeah, thanks for having me.
This is great.
Speaker 1 (25:46):
Absolutely.
If you're a CE plan subscriber,be sure to claim your CE credit
for this episode of GameChangers by logging in at
ceimpactcom and, as always, havea great week and keep learning.
I can't wait to dig intoanother game changing topic with
you all again next week.
Hey CE Impact subscribers.
Welcome to the Game ChangersClinical Conversations podcast.
I'm your host, Josh Kinsey, andas always, I'm super excited
about our conversation today.
Stroke remains one of theleading causes of death and
disability.
The new AHA-ASA StrokePrevention Guideline provides
critical updates to enhanceprevention efforts.
Today, we'll explore these keyupdates and discuss how
(00:30):
pharmacists can play a pivotalrole in implementing
evidence-based stroke preventionpractices.
It's so great to have JustineGuyton as our guest expert for
this episode.
Welcome, Justine.
Thanks for joining us.
Speaker 2 (00:39):
Thanks so much for having me.
Speaker 1 (00:40):
Yeah, so before we jump in, in case our learners
are not familiar with you, giveus a little bit about your
background, maybe a little bitabout your practice site and why
you're passionate about thistopic today.
Speaker 2 (00:52):
Yeah, thank you.
So I practice in ambulatorycare, so I am in a primary care
clinic at a department of publichealth, so I get to work with a
lot of patients that areunderinsured and have a lot of
different factors impactingtheir access to healthcare.
So it's a really kind ofinteresting place to be a
pharmacist trying to applyguidelines, kind of, with
(01:12):
another layer of patient care inthere.
Speaker 1 (01:15):
Yeah, that's great, that's awesome.
Yeah, I appreciate your servicein that realm and also again
appreciate you joining us today.
So, thank you.
Let's jump into just kind oflaying I always like to lay the
groundwork.
My listeners have gotten usedto me kind of making sure the
foundation is laying.
We're all on the same pagebefore we start talking.
So just again, review for usthe prevalence of stroke, like
(01:37):
how impactful is it on publichealth?
It's probably more common thanwe realize.
So let's just kind of lay thatfield first and talk a little
bit about the prevalence ofstroke and maybe you know like
the history of the guidelinesand where they came from and
that kind of thing.
Speaker 2 (01:52):
Yeah, so just wanted to reiterate these guidelines
are the primary preventionguidelines.
So the whole kind of focus ofthese guidelines is about
preventing stroke, preventing afirst stroke.
So there's going to be adifferent set of guidelines for
patients that have already had astroke.
So really prevention is kind ofthe key word in this
conversation.
Today.
There's hundreds of thousandsof patients that are having a
(02:13):
first stroke each year and Ieven heard a stat that at least
half of those are thought to bepreventable.
So I think that's really kindof the impetus for this
guideline is just how impactfulstroke can be with morbidity,
mortality and kind of likeimpact on somebody's life.
And then knowing that half ofthose could have been prevented.
It's obviously really importantthat we have recommendations
(02:33):
that are available to helppeople kind of understand how to
prevent them.
Speaker 1 (02:37):
Wow, yeah, yeah, that's a wild stat to know that
so many could have beenprevented.
So, again, it's why educationis key and that we're making
sure that our pharmacists outthere are on the front lines
trying to prevent these.
So you mentioned the strokeprevention guidelines and tell
(02:58):
us about the significance ofthem.
You and I talked previously andyou reminded me that they only
come out once every 10 years orso, so clearly this is a big
deal that we're talking aboutthe updates.
So maybe what informs thoseupdates?
And just a little history aboutthe guidelines in general.
Speaker 2 (03:14):
Yeah, so you're right , this is the first time these
prevention guidelines have beenupdated in 10 years, so
obviously there's been a lot ofinformation that's come out in
the meantime, so that's a bigimpetus for this change.
I'd say, when I was lookingthrough the guidelines I saw
kind of two big areas that Ithink are noteworthy.
So one I think one of the waysthat they kind of really focus
the guidelines and are kind ofdiscussing them, if you will,
(03:37):
has been kind of simplified.
So there's a term called AHA,so American Heart Association's
Life's Essential Eight, and sothat's kind of a new way of
thinking about, or maybeorganizing it in your brain, a
lot of these things that we'lltalk about as far as what the
recommendations are.
And then I think the other bigthing that I noticed was a
couple new risk factors had beenidentified maybe in the past 10
years and had been included inthese guidelines.
(03:59):
So those are kind of the twobig areas that I saw being
updated.
Speaker 1 (04:02):
Yeah, and that's a key one in my opinion the risk
factors, because again, that'ssomething else for us to be on
the lookout for, since we areoften the first and most common
healthcare provider that ourpatients see.
(04:22):
Because you know it's often thatthey see us, and opposed to an
annual physical or whatnot.
So right, yeah, okay, that'sgreat.
So let's jump into a little bitabout what are some of the
opportunities.
So we always like to try toprovide our listeners and our
learners with opportunities thatthey can employ at their
practice site.
So what can we do aspharmacists?
How can we expand our roles?
What are some of the areas andthings that we can do to help
prevent strokes?
Speaker 2 (04:43):
Yeah.
So I think, kind of thinkingabout this, there's just so many
ways I could I could tacklethis question, or pharmacists
could be involved, going back tothe AHA like life's essential
aid it's really the AmericanHeart Association kind of
discussing eight differentfacets of like everyday life
that we should be payingattention to.
That impact stroke.
So that, right, there is eightdifferent ways.
(05:03):
So those areas are going to beblood sugar, blood pressure,
weight management, lifestyle.
So food choices, exercisechoices, sleep a lot of
different areas, and so thoseare all smoking cessation, so
those are all the different waysthat we know somebody is going
to be.
Day-to-day life, lifestyle orrisk factors are implementing or
(05:24):
impacting their stroke risk.
So simple things.
I mean, I don't know how manypatients fully realize that
their blood pressure needs to becontrolled, not just for the
sake of the number of theirblood pressure, but what that
blood pressure has an effect on,so things like increasing
stroke risk.
So I think people know ifstroke is bad, want to get my
blood pressure controlled, butthey don't necessarily always
(05:45):
connect those and so just evenletting patients know why it's
important that they take theirblood pressure medicines every
day, not just to get that numberdown, even if they feel okay,
but because that's impactingtheir stroke risk.
It's kind of one way that Ithink about that.
Speaker 1 (05:59):
Yeah, absolutely so.
Adherence is key formedications that your patients
are already taking.
So, again, that would be alight bulb for you as a
pharmacist when you see apatient who is on a blood
pressure medication.
Okay, this is a patient who isat risk for stroke.
Speaker 2 (06:16):
And so that's where I need to be preventing.
Speaker 1 (06:18):
So, again, educating the patient that adherence is
key, making sure that they Ilove your comment of take it,
even if you feel.
Well, you know, because it's somany, so many patients that
just, oh, I felt I felt finethis morning.
I didn't feel like my bloodpressure was high or my sugar
was fine this morning orwhatever.
Well, it probably is becauseyou've been taking your medicine
(06:39):
, so let's continue, you know.
But yeah, so that's that'sreally important as well.
What are some of the other?
So you mentioned glucosecontrol and weight management.
So, like, what are some of thethings that we can look for?
Obviously, we can look for apatient who's on a diabetic
medication diabetes medication.
But like, what are some of theother things that we can kind of
(07:01):
just keep our eyes open for andbe like, oh, that's an at-risk
patient for a stroke?
Yeah.
Speaker 2 (07:06):
Yeah, so you're right , diabetes is one.
Another one that maybe wouldtake a little bit more digging
would be looking at patients tosee if they're candidates for
cholesterol medicine so statinsessentially.
So we know that increasedcholesterol, especially LDL,
increases stroke risk.
Many different sets ofguidelines are going to assess
patients and their statin riskand if they would benefit from a
(07:27):
statin.
And we definitely know thatthose high risk patients so the
really high LDL is like 190 andabove or when we use the 10-year
ASCVD risk calculator ifanybody has that app it's what I
often use to calculate itreally fast but those with
elevated risk or elevated riskand risk factors are going to be
patients that need to be on astatin and kind of like blood
pressure, but maybe a little bitdifferent.
I think cholesterol is evenmore confusing for patients
(07:50):
because sometimes like theirnumber looks OK but really we're
looking kind of more globallywith those risk factors and what
that percent 10 year risk is todetermine if they benefit from
the statin.
And so I think that one doesn'talways like strike patients as
like why they need to takecholesterol medicine, or if
they're even a candidate for one.
Speaker 1 (08:07):
The guidelines are pretty straightforward about who
should be initiated on one, soI think that's another one that
if you have access to checkinglipids, you'll be able to
determine if a patient wouldbenefit from the statin pretty
quickly, yeah, and I know fromexperience I'm assuming it still
is the case but a lot of MTMopportunities are out there
about statins and making surethat everyone is available.
(08:29):
Everyone that's eligible for astatin has at least been
introduced to it or it's beendiscussed with them.
So, yeah, that's a great callout as well, somewhere that we
can start with prevention.
And you mentioned weight andexercise.
So let's talk a little bitabout those, how they impact and
maybe how, as a pharmacist, wecan kind of call those out too.
Speaker 2 (08:48):
Yeah, I think big picture, the lifestyle
recommendations that are inthese guidelines are for
prevention.
So if you're thinking about itfrom that perspective, they're
really recommendations foreverybody.
I try to remind my patients ofthat.
This is not just for youbecause you have diabetes or
because you have a stroke risk.
Really it's for everybody forrisk reduction.
(09:12):
So exercise recommendations are150 minutes of moderate
intensity activity, which mightnot really sound very specific,
but that's kind of a brisk walkwhere you're kind of walking
pretty quickly, you can stilltalk and everything, but you're
putting some effort into it.
Um, or 75 minutes of, uh,vigorous activity in a week.
So that'd be something likejogging or anything more intense
than that.
But those recommendations arereally for everybody and so
(09:34):
that's something that any youcould talk to any adult about in
terms of like lifestyle, likefood intake.
Um, one of the bigrecommendations for many
different prevention guidelinesis the Mediterranean style of
diet.
Speaker 1 (09:47):
Got it, Got it.
That's great, Super helpful.
So what are the guidelines?
Again, their prevention.
So is there anything that weneed to be like integrating or
implementing into, or is it?
Or is it strictly just becausetheir prevention and pretty much
(10:09):
all of our patients are goingto have one of those things?
If your patient is in yourpharmacy, they're probably there
for blood pressure, diabetes,obesity, you know they're
probably there for somethingright?
So is there any other thingthat we need to kind of keep in
mind as far as, like picking outwho we should be targeting to
talk to about the preventivetherapies, or have we covered
(10:29):
all you think?
Speaker 2 (10:30):
I really think that you know everybody should be
having these conversations.
I think that's a big part ofthe push of the guidelines is
making sure that patientsunderstand their risk factors
factors so not every single oneof them can be fixed, but
patients can understand kind ofwhat their baseline risk is and
that they are at risk for astroke and why maybe some of the
things that are modifiable areimportant.
So I do think that theconversation is worthwhile.
(10:53):
In adults, obviously there'ssome patients that might have a
bigger magnitude of benefit thanothers.
But I think that this issomething that you can pick
maybe one or two of those life'sessential eights and see if
that doesn't like make moresense for you to implement into
your practice.
I definitely can agree thattalking to every patient about
eight different factors ofchange could be really
(11:13):
cumbersome.
Take your whole day.
You know not leave a lot oftime for other things, but maybe
picking like one or two.
That makes sense for your site.
Speaker 1 (11:21):
Yeah, that's great and I love that you called out
to the modifiable ones.
I think that that's reallyimportant to kind of explain to
patients and, in a sense of like, here's what I mean.
Here's what we mean bymodifiable.
It's things that you canactually proactively make a
change for.
So yeah that's key.
Um, okay, great, so let's moveinto then some of the challenges
(11:42):
.
So we talked you briefly, justtouched on a challenge, which is
time.
Right In the pharmacy practicesetting.
We all know that if we couldall wish for one thing, it would
be more time or more assistance, more staff to help with that.
Give us more time.
So obviously that's a barrier.
What are some of the otherchallenges and barriers that you
think are going to impede usfrom helping to carry out and to
(12:08):
kind of target these patientsand kind of implement the
guidelines along the way, likeyou mentioned?
Speaker 2 (12:14):
Yeah, I mean, you're definitely right, time is going
to be a challenge.
So I think that, like kind ofstarting strategically and
figuring out maybe who yourhighest risk patients are you
know, looking by blood pressuremedicine or statin or whatever
it might be might be a way tokind of target that.
I think the other thing thatcan be a challenge is making
sure that pharmacists have somesort of way to implement change.
So ideally, you know, we wouldidentify a change that needs to
(12:38):
be made and also be able toimplement that, whether it's
through an MTM or having arelationship with a provider or
some sort of useful way to kindof contact a prescribing
healthcare provider.
If you're not able to do, thatare going to be some of the ways
to be able to have a big impact.
If you're kind of in thecommunity setting, yeah, that's
great a big impact if you'rekind of in the community setting
.
Speaker 1 (12:58):
Yeah, that's great.
A lot of patients who as we'vetouched on, a lot of patients
who are at risk for a stroke,have a lot of comorbid
conditions, so they're going tobe complex patients.
What are some of the other keythings that we can attack with
(13:18):
these patients?
What are some of the thingsthat we can spend time on and
that we can put our effort into?
Speaker 2 (13:23):
Yeah, the way that I like to approach that is kind of
almost from the flip side ofI'll often talk to patients
about.
Like you know, there's lots ofrecommendations in this area,
this area and this area.
Is there something that you'vebeen thinking about that you'd
like more information on, or isthere one of these areas that
you're interested in targetingthat I can kind of help you make
a specific plan with and I'llkind of try to work with where
they already kind of maybe havethat intrinsic motivation and
(13:45):
they're maybe excited aboutsomething or had been thinking
about something?
and try to run with that first,versus coming at a patient, kind
of cold, saying you really needto quit smoking, you know, and
that's just not what they'reready to do, but maybe they are
willing to, you know, work ontheir diet and change something
different about the way thatthey're eating and their eating
habits yeah, absolutely,absolutely.
Speaker 1 (14:04):
what are some of the opportunities for us as um
healthcare providers?
Are there any opportunities forus to collaborate with other
healthcare providers, like whatyou?
You mentioned weight nutrition,so that kind of made me think
about that.
Is there anybody else that wecould be collaborating with and
to make sure that our patientshave access to everything they
(14:27):
need?
Speaker 2 (14:27):
Yeah, I think it really just depends on the
patient.
But you're right, there aresome patients who would benefit
from a little bit of lifestyleeducation and like what a
Mediterranean diet is, but somethat would really benefit from
and are eager to learn more andmight having a relationship with
a nutritionist might be thebest thing for them.
Same thing with physicaltherapy.
I've definitely have somepatients that maybe have a bad
(14:49):
back or a bad knee or somethingand they want to exercise or get
more active and get moremovement into their life.
But they're really just notsure how.
Those are great kind of sparksto kind of like be able to refer
out or have them talk to theirprovider about getting a
referral to something likephysical therapy and thinking
about what would be safe andeffective movement for them,
kind of in the place thatthey're at.
Speaker 1 (15:09):
Yeah, that's good, that's great.
So you had mentioned, obviously, your background in the public
health kind of sector and youhave a lot of patients who are
underinsured and don't havegreat access to care, so let's
talk about that.
That's obviously a challenge aswell.
What?
are some of the tips and tricksyou can share with our listeners
about ways to overcome theaccess to care, the cost of
(15:31):
medications.
We all know that both of thosethings can affect adherence in
patients, and if a patient hasbad blood pressure and they're
not adhering on their med, thenthey're at risk for you know.
So like it all boils down, itboils back to this.
So anything you can kind ofshare with us there that you've
learned in your.
Speaker 2 (15:49):
yeah, this might be kind of old news to some people,
but kind of the things that Ithink about is just any of the
generic combination medicineswhere I can lower the copay by
just having one copay instead oftwo is something I jump to kind
of right away.
We use a lot of copay cards forbrand name medicines, trying to
(16:09):
get them down a little bit forpatients, especially beginning
of the year, if they have highercopays or if their insurance
has them at the higher tier.
We use things like, even likeGoodRx, just to look quickly at
different pharmacies, at whatmaybe a comparison might be for
the cash price of a medicationat a couple different places.
And then we have enoughpatients that don't have any
(16:29):
insurance at all that we dopretty routinely use the
manufacturer's coupons, so kindof the patient assistance
programs through themanufacturers directly.
That's definitely a morecumbersome process.
It includes, you know, theprovider, the prescriber's
signature, the patient'ssignature, their financial
information.
But for some people you knowit's a really necessary step for
(16:52):
them and they're willing to dothe work of bringing it back.
Yeah.
Speaker 1 (16:55):
Yeah, and because it could be game changing for
especially if it's, you know, ifthey failed on other therapies
and this is the one thatactually is finally working and
you know they're willing to gothrough that.
So, and you know one thing thatyou mentioned there even you
didn't mention it, but I'llthrow it in.
You kind of touched on it.
You know we have training forcommunity health workers.
Know we have training forcommunity health workers.
(17:20):
Yeah, they are really trainingtechnicians in that space to be
kind of the right hand.
They're already the right handpeople in our pharmacies and so
now they're, you know, beingtrained in that public health
space to identify theseopportunities.
And so you'd mentioned thatthat was the work could be
cumbersome sometimes, but, butyou know, if you have a CHW or
if you have a technician, thatwas the work could be cumbersome
sometimes, but but you know, ifyou have a CHW or if you have a
technician that's willing to gothrough that training, that's
(17:43):
also something they can do.
And they can also help identifyother solutions for food
insecurities and transportationinsecurities and other things
that we see.
Because, let's be honest, ifyou have a patient who's
underinsured and they're seeingyou at a clinic.
You know, at a public accessclinic they probably have other
insecurities and issues.
(18:04):
Yeah for sure.
Okay, so let's talk through alittle bit then, too, about I
know myself, as when I practicedit's been a while, but when I
practiced and when I actuallypracticed pharmacy, it was
oftentimes in the communityspace, and so you know we do a
(18:27):
lot of medication dispensing andeducation about things new
medications, making sure they'reinherent and everything but we
don't always get to or do weshould, but we don't always stay
up to date with the guidelines.
So why is it important for allpharmacists to stay up to date
with this?
Why is you know if you can juststress the importance that like
(18:49):
it's impactful and it reallymakes a difference and just kind
of shed?
some light for us.
Speaker 2 (18:55):
Yeah, I would say big picture.
I think cardiovascular healthis definitely one of the ones
that we're just seeing a lot inlive more and more new trials
coming out and data coming outand, obviously, guideline
updates.
So to me it definitely standsout as a space where we're
seeing a lot of change andseeing a lot of data and newer
medications that can be helpful.
Maybe not anything thatspecifically hits like the AHA,
(19:18):
asa, stroke preventionguidelines specifically, but I
think when we think about thatspace, especially with patients
with diabetes, we're definitelyseeing like an explosion of
medication classes that haveglucose lowering benefit and
then the GLPs as a class arelinked to stroke lowering
benefit.
So when I'm talking to patientsabout why I want them to start
an injection for the first time,the fact that I know that it
(19:39):
helps lower their blood sugarsbut it also helps lower their
cardiovascular risk, is aselling point that I can kind of
help them with to betterunderstand why this medicine is
important versus maybeincreasing their metformin dose
today.
Speaker 1 (19:53):
Absolutely.
Yeah, that's important.
So are there any otherchallenges that you've seen with
?
You know, pharmacists on thefront line of trying to
implement these preventionguidelines, anything else that
you can be like, you wouldn't bethe only one.
Here's the way around it.
Anything that we've missedtoday that you want to share?
Speaker 2 (20:17):
I can't think of anything big.
I think probably just like oneof the biggest challenges is
just how many opportunitiesthere are here.
So figuring out, like which oneyou want to do, or all eight of
them, like you know,implementing them into a
practice can be challenging.
Speaker 1 (20:25):
Yeah for sure.
Speaker 2 (20:26):
And then I think, just the time some of these it's
not like as straightforward aslike treatment guidelines are.
So just to kind of flip thatlike if you have a, a stroke and
you go to the hospital, youknow, you know you're getting X,
Y and Z medicine for thatstroke, you know what just
happened, it was uncomfortable,You're probably scared, You're
getting discharged soon and thelength of medication to like
(20:47):
what its goal is, is very clear.
I think when we're talkingabout prevention it becomes a
little bit less clear, it's alittle more nebulous.
It's like, oh, my future selfin five to 10 years.
So anytime that you have arelationship with a patient and
you already know them and youcan kind of explain these things
, I think that it makes it moreimpactful versus just somebody
yakking at you with you shouldlose weight or you should eat
(21:09):
healthy For sure, and connectingthose dots for the patients.
Speaker 1 (21:13):
I think that's a great point.
Like sometimes even with ustelling them like your weight
and you know your weight is afactor in your risk for a stroke
like, but, but why and and?
Okay, so my blood pressure is afactor, but like why and why
(21:33):
does me taking my medicine forblood pressure make that
decrease?
You know, so that risk factordecrease.
So I think it's important,again, connect those dots.
So to me it sounds like one ofour biggest roles as a
pharmacist is education, patienteducation, yeah, and just
making sure that we are up todate on the most important
(21:54):
information so that we can shareit with our patients
appropriately.
Speaker 2 (21:57):
Yeah, and I would also challenge listeners to kind
of think about the fact that Ilike to practice what I preach,
if you will.
So these are things that all ofus should also be doing, and I
think, the more that you kind ofremember that these also apply
to you, you should be thinkingabout these in your own life,
and then I think that makes formore meaningful conversations
with patients when you're likeyeah, I love to eat cookies too.
(22:19):
Like goodness, it's Girl Scoutseason right now and the cookies
are coming out and I'm going tohave a hard time, but what I'm
going to do instead is X, Y or Z, and this is what's helped me.
I think sometimes that can helpyou in practice kind of connect
with patients a little bitbetter and kind of remember this
is really something foreverybody.
Speaker 1 (22:36):
Yeah, that's great.
Well, so, as kind of just likea summary, I just want to
reiterate again because we'vegiven a lot of information out
there for our listeners.
It's not anything new to them.
They're used to me throwingtons of stuff at them, stuff at
them.
So let's just kind of I alwayslike to do a summary and kind of
wrap it back up with, like Ithink and correct me if I'm
(22:58):
wrong but what I'm hearing yousay is pick a few, like there's
no way that we can possibly doeverything that the guidelines
suggest, right, the preventionguidelines.
But to pick a few, and I thinkthat some of that low hanging
fruit is looking for patientswho are on a blood pressure
medication.
I think that some of the thatlow hanging fruit is looking for
patients who are on a bloodpressure medication.
Like that's, that's a first,that's a first step Patients who
(23:18):
are on diabetic medications,patients who we know to be obese
or have struggled with weightor nutrition in the past.
And then you know that can,that can go down many routes,
because that can bring in your,your exercise and all that kind
of stuff as well, um, and reallyfocus on adherence, right.
(23:41):
So that's, that's a key, keyone as well, um, adherence and
education and targeting maybethose patients that we know to
be diagnosed with something orhave a comorbid condition or
something.
Speaker 2 (23:54):
Yeah, yeah, absolutely Okay great, all right
.
Speaker 1 (23:57):
Well, I learned.
I learned stuff as well.
That's great.
Okay, so, like, what I alwayslike to do at the end is give
you a chance to tell us what thegame changer is.
So, summarizing kind ofeverything.
I did a summary here, but, like, what is the game changer?
Why do listeners need to walkaway from this episode and do
(24:17):
this?
Why do they need to implementthis?
Why do they need to targetthose patients?
Speaker 2 (24:21):
So tell us what the game changer is.
I think, if I was going tosummarize, I would just remind
everybody that half of strokesare preventable and there are at
least eight different ways thatwe can help patients reduce
their risk of stroke through theAHA's Life's Essential Eight.
These are things that patientscan do with lifestyle, so
education can be implemented,and then medication and
adherence all play a factor inthat.
(24:43):
So knowing that there is suchroom for improvement in
population health and knowingthat we see patients every day,
it just means that there's somuch room for a pharmacist to be
involved.
Speaker 1 (24:52):
Yeah, that's great, that's great.
I just had this wild thought.
I'm not wild, I'm sure manypeople thought of it before and
they've probably done it butanother way to simply do it,
because you're saying that halfare preventable.
Again, that's such an impactfulstatement.
But even if you did somethingas simple as putting a flyer at
your register if you're in acommunity practice or, you know,
(25:14):
maybe it's a flyer on a standin your waiting area if you're
in an amcare clinic or something, but that saying did you know
that half of all strokes arepreventable, are you at risk?
You know, ask the pharmacistfor more information, or
something.
So I think that, um, justreally kind of putting yourself
out there as that expert, um,because we are and just really
(25:38):
kind of owning that.
So, yeah, okay, great, this wasgreat.
Justine, thank you so much forjoining us today.
I appreciate it.
Speaker 2 (25:44):
Yeah, thanks for having me.
This is great.
Speaker 1 (25:46):
Absolutely.
If you're a CE plan subscriber,be sure to claim your CE credit
for this episode of GameChangers by logging in at
ceimpactcom and, as always, havea great week and keep learning.
I can't wait to dig intoanother game changing topic with
you all again next week.
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