Effects of Telepharmacy in Post Ischemic Stroke Patients: A Randomized Controlled Trial

Purpose: To compare pharmacist-led telepharmacy with standard pharmaceutical care on stroke and medication knowledge, medication adherence, and clinical outcomes (blood pressure [BP], low-density lipoprotein cholesterol [LDL-C], and glycated hemoglobin [HbA1c]) in patients with post-ischemic stroke; and to characterize medication-related problems (MRPs) and their severity in the telepharmacy arm. Methods: In a randomized controlled trial, 126 hospitalized adults with ischemic stroke were assigned 1:1 to receive either standard pharmaceutical care alone or standard care plus structured telepharmacy follow-ups at 1 week, 1, and 2 months post-discharge (n = 63/arm). Outcomes were assessed using validated tools, including knowledge questionnaires; the Medication Adherence Scale for Thais (MAST); the Pharmaceutical Care Network Europe (PCNE); classification v9.1; and the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) severity index. Results: Compared with controls, telepharmacy improved post-discharge knowledge (11.75 ± 2.38 vs 9.79 ± 2.43; P < .001) and adherence (MAST 37.00 ± 3.45 vs 33.26 ± 3.76; P < .001). BP target attainment (<130/80 mmHg) was higher with telepharmacy (52.4% vs 30.2%; P = .011). Follow-up BP favored telepharmacy: systolic Δ −3.67 mmHg (95% CI −6.79 to −0.55; P = .041) and diastolic Δ −3.11 mmHg (95% CI −5.99 to −0.23; P = .040). Between-group differences were not significant for LDL-C or HbA1c. In the telepharmacy arm, 76 MRPs were identified; the most frequent problem was unnecessary drug treatment (38.16%), commonly due to patients’ decision to use unnecessary drugs (28.93%). Patient counseling was the commonest intervention (40.00%); 83.64% were fully implemented and 92.10% of MRPs were completely resolved. An ~36.84% of MRPs were NCC MERP level E. Conclusions: Telepharmacy improved knowledge, medication adherence, and BP control after ischemic stroke, and enabled effective identification and resolution of MRPs. These findings support incorporating pharmacist-led telepharmacy into post-discharge transitional care pathways. The trial was retrospectively registered (TCTR20250401004). https://www.thaiclinicaltrials.org/show/TCTR20250401004