The screening processes implemented in this study captured an
important subgroup of SPC clients with complex health care
management needs meriting a practice enhancement. Clinic
practice at the study site nowincorporates self-efficacy and adherence
screening questions into assessment. Cognitive assessment
testing occurs if the nurse or neurologist assesses client problems
in providing a history, uncertainty about medications taken,
and/or if clients or familymembers identifymemory deficits and
confusion. With client permission, if medication adherence is
uncertain or if they are unable to provide a list of theirmedications,
their community pharmacist is consulted to verifymedications
and renewal patterns. Home self-monitoring equipment is
available on loan. Clients with blood pressures above national
stroke recommended levels are requested tomonitor and record
their blood pressure on a weekly basis and bring their records to
their SPC visits. Alternatively, clients are now invited to email or
fax records to the clinic nurse between appointments.