Promoting Adherence to Regimen of Risk Factor Modification by Trained Non-Medical Personnel (Volunteers) Evaluated against Regular Practice Study (PARTNERS):

Project Leader:

Richard Chan, University of Western Ontario.

Project Team:

Vladimir Hachinski, University of Western Ontario
Allan Donner, University of Western Ontario
Sumit Majumdar, University of Alberta
Finlay McAlister, University of Alberta
Robert Nolan, University of Toronto
Michael Harnadek, London Health Sciences Centre
Cheryl Mayer, London Health Sciences Centre
Leanne Casaubon, University of Toronto
Demetrius Sahlas, University of Toronto
Michel Beaudry, neurologist, Chicoutimee, QC
Brian Buck, neurologist Edmonton, AB
Barbara Hoppe, Memorial University of Newfoundland
David Howse, neurologist ,Thunder Bay Regional Hospital, ON
John Maher, neurologist, Barrie, ON
Arturo Tamayo, neurologist, Brandon Regional Hospital, MB

Project Summary:

PARTNERS is a project to identify the best strategy to reduce the impact of uncontrolled vascular risk factors in patients at high risk of developing ischemic strokes. Timely pharmacological interventions and the adoption of a healthy lifestyle can reduce the risk of stroke, but adherence to a regimen is crucial to success. Adherence is, in turn, dependent on the patients’ understanding of the effect of vascular risk factors, especially hypertension. The study will examine the efficacy, durability, and cost-effectiveness of a volunteer-facilitated risk modification program, compared against regular practice in patients who have experienced recent ischemic cerebrovascular events.

There will be 632 patients enrolled from 10 clinical centres in Canada. Patients are eligible for the study if they have experienced a recent ischemic cerebrovascular event and have hypertension. Participants will be randomized to receive regular practice (RP) or regular practice plus volunteer-facilitated risk modification program (RV). Patients in the RP group will receive usual medical care plus a 30-minute risk factor counseling by a nurse immediately following randomization. Patients in the RV group will receive standard medical management and 10 clinic or telephone contacts with the volunteer in the first year of follow-up. The volunteer will serve as an educator, a motivator, and a peer supporter. All patients will be followed by telephone contact or clinic visit every three months for two years. Primary outcome measure is the reduction in systolic BP from baseline to 12 months. Secondary outcome include measures of efficacy (magnitude of change in vascular or behavioral risk factor profile from baseline to 12 months), durability (magnitude of change in vascular or behavior risk factor profile from baseline to 24 months), clinical events (stroke, myocardial infarction, and/or death, cognitive decline), quality of life, and cost effectiveness of the intervention.