Pharmacists Give Bad Advice on Stroke Symptoms

Newswise — Building on separate studies showing that primary care doctors' offices and "healthline" operators at academic hospitals fail to recognize stroke symptoms when asked for medical advice, a WVU research team has confirmed that pharmacists are equally likely to make the same mistakes.

In research dating back at least five years, WVU emergency medicine physicians have presented a hypothetical stroke scenario " difficulty speaking and weakness on one side of the body " to various medical professionals and members of the public.

The correct response would be to advise the caller to seek 911 transport to a hospital emergency department, where so-called "clot-busting" drugs administered within a three-hour window can help many stroke victims.

In the new study, WVU researchers called 71 pharmacies, posing as persons asking about a 68-year-old mother who was having trouble talking and experiencing paralysis on her left side. Four of five pharmacies gave out incorrect information, failing to urge the caller to seek immediate emergency help.

"In all of the studies we have undertaken during the past five years " whether we're surveying primary care doctors or elderly people at senior centers " we find that about 30 percent say that the proper response to such symptoms is to wait and see if they get better," said Charles Whiteman, M.D., a doctor of emergency medicine at WVU.

"This is exactly the wrong response, because clot-busing drugs are effective only if administered during that three-hour window," Dr. Whiteman explained. "After arriving at the emergency room, the patient must first have tests to make sure there's been no bleeding in the brain. Delay in seeking treatment burns through that three-hour window."

The pharmacists weren't simply asked to respond out of the blue. They were given four possible choices " should we take our 68-year-old mother to the hospital, call for an ambulance, consult her primary care doctor or just wait to see if her symptoms resolve?

Even with the prompting, only one out of five pharmacies chose the correct course of action. In the majority of the calls, the person giving the advice was the pharmacist himself or herself. Of the 71 responses, only five came from technicians or assistants and one came from a pharmacy student.

A.J. Monseau, M.D., a second-year emergency medicine resident at WVU and lead author, presented a poster titled "Advice to a Stroke Scenario by Pharmacists in the United States" at the American Stroke Association's International Stroke Conference Feb. 17 to 20 in San Diego.

An abstract of previous WVU research involving primary care physicians' offices was published in the medical journal Stroke in 2008. In 2007 Stroke published results of the WVU study involving national healthline operators.

WVU researchers also have asked the stroke-scenario question of people at shopping malls and the elderly at seven senior centers in West Virginia. All of the studies have shown similar results: approximately 30 percent of respondents choose the wait-and-see course of action, Whiteman said.

Whiteman explained that pharmacists were chosen for the most recent study because a national pharmacy chain was advertising its pharmacies as a place for the public to turn to for medical advice.

Just as the public has been schooled to seek treatment immediately when heart-attack symptoms occur, people must also understand the urgency of seeking emergency help when symptoms suggest the onset of a stroke, Whiteman said. Educational campaigns should target not only older people who are at higher risk of stroke but also those who care for them such as close family members and all types of health providers.