Conclusions
An expanded NCM care delivery model that included an
extended follow-up for those SPC clients with probable TIA
or confirmed stroke, uncontrolled hypertension and additional
risk associated with deficits in cognition and medication
self-efficacy and adherence was feasible within current clinical
operations with only a modest impact on nursing
resources. In addition, the results suggested that a cluster of
nurse-led case management follow-up interventions tailored
to support self-management has potential to improve riskfactor
management and medication self-efficacy and adherence
outcomes in order to reduce risk for stroke.