A Nurse Practitioner-Led TIA/Stroke Program To Serve Rural Northwest Montana

Abstract

Cerebrovascular accidents (CVAs) are identified as the principal cause of long-term severe disability in the United States (American Heart Association, 2012). Cerebrovascular accidents (CVAs) are the fourth leading cause of mortality in the United States (Minino, Murphy, Xu & Kochanek, 2011). Small towns and rural areas are currently in a health care crisis. With most subspecialty services located in metropolitan areas, distance and lack of accessibility creates disparity in evidence-based practice implementation. The growing gap between the health of rural and urban Americans is evident and will widen without proper interjection (Alkadry, Wilson, & Nicholas, 2006; Brown, Lisabeth, Roychoudhury, Ye, & Morgenstern, 2005; Sacco et. al, 2006). While there have been significant recent advances to support patients during the acute phase of a stroke in Montana, guidance for primary care providers and patients is currently limited for secondary stroke prevention services in the state, including Northwest Montana. Current morbidity and mortality data due to stroke in rural northwestern Montana may reflect a gap between existing guidelines for secondary risk reduction and the current practice of instituting those prevention guidelines. Effective secondary stroke prevention strategies are those that are based on a model of care that is evidenced based, feasible, and meets the unique needs of the population. A qualitative descriptive design was used to achieve the AIMS of this study. A critical analysis of the literature was used (AIM 1) to identify previously published information related to TIA/stroke clinics and programs. Focus groups were used (AIM 2) to elicit information from health care professionals in northwestern Montana about the need for and preferences for an advanced practice nurse-run stroke/TIA clinic. We found that like other reports from rural sectors, Primary Care Providers and Neurology providers in Northwest rural Montana identified challenges in access to care and cultural influences on patient adherence. It was evident that Primary Care Providers and Neurology providers were in favor of instituting a Nurse Practitioner-led secondary prevention program for stroke and TIA. We propose a stroke/TIA program to serve Northwest rural Montana that includes Nurse Practitioner-led transitional care services, care coordination, and education and program evaluation services.