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Hall P, Lawrence M, Kroll T, Blake C, Matthews J, Lennon O. Reducing risk behaviours after stroke: An overview of reviews interrogating primary study data using the Theoretical Domains Framework. PLoS One 2024; 19:e0302364. [PMID: 38669261 PMCID: PMC11051587 DOI: 10.1371/journal.pone.0302364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Lifestyle changes, in addition to preventive medications, optimise stroke secondary prevention. Evidence from systematic reviews support behaviour-change interventions post-stroke to address lifestyle-related risk. However, understanding of the theory-driven mediators that affect behaviour-change post-stroke is lacking. METHODS Electronic databases MEDLINE, Embase, Epistemonikos and Cochrane Library of Systematic Reviews were searched to March 2023 for systematic reviews addressing behaviour-change after stroke. Primary studies from identified systematic reviews were interrogated for evidence supporting theoretically-grounded interventions. Data were synthesized in new meta-analyses examining behaviour-change domains of the Theoretical Domains Framework (TDF) and secondary prevention outcomes. RESULTS From 71 identified SRs, 246 primary studies were screened. Only 19 trials (N = 2530 participants) were identified that employed theoretically-grounded interventions and measured associated mediators for behaviour-change. Identified mediators mapped to 5 of 14 possible TDF domains. Trial follow-up ranged between 1-12 months and no studies addressed primary outcomes of recurrent stroke or cardiovascular mortality and/or morbidity. Lifestyle interventions targeting mediators mapped to the TDF Knowledge domain may improve the likelihood of medication adherence (OR 6.08 [2.79, 13.26], I2 = 0%); physical activity participation (OR 2.97 [1.73, 5.12], I2 = 0%) and smoking cessation (OR 10.37 [3.22, 33.39], I2 = 20%) post-stroke, supported by low certainty evidence; Lifestyle interventions targeting mediators mapping to both TDF domains of Knowledge and Beliefs about Consequences may improve medication adherence post-stroke (SMD 0.36 [0.07, 0.64], I2 = 13%, very low certainty evidence); Lifestyle interventions targeting mediators mapped to Beliefs about Capabilities and Emotions domains may modulate low mood post-stroke (SMD -0.70 [-1.28, -0.12], I2 = 81%, low certainty evidence). CONCLUSION Limited theory-based research and use of behaviour-change mediators exists within stroke secondary prevention trials. Knowledge, Beliefs about Consequences, and Emotions are the domains which positively influence risk-reducing behaviours post-stroke. Behaviour-change interventions should include these evidence-based constructs known to be effective. Future trials should address cardiovascular outcomes and ensure adequate follow-up time.
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Affiliation(s)
- Patricia Hall
- School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin, Ireland
- iPASTAR (Improving Pathways for Acute Stroke and Rehabilitation) Collaborative Doctoral Award, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maggie Lawrence
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, Health Science Centre, University College Dublin, Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin, Ireland
| | - James Matthews
- School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin, Ireland
| | - Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin, Ireland
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V R, Chacko AM, Abdulla N, Annamalai M, Kandi V. Medication Adherence in Cancer Patients: A Comprehensive Review. Cureus 2024; 16:e52721. [PMID: 38384629 PMCID: PMC10880514 DOI: 10.7759/cureus.52721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Cancer is a complex disease that can affect different parts of the body. The rates of cancer have shown an increasing trend in the past decade. A majority of cancers are detected late, therefore becoming untreatable and resulting in significant mortality. Additionally, the lack of awareness about cancers, their risk factors, diagnostic modalities, and preventive measures contributes to increased burden among people. Despite significant developments in the therapeutic and comprehensive management of cancers, the cause for concern is the lack of medication adherence. This is majorly attributed to the adverse effects of the medication, the cost of the drugs, and other reasons. This review comprehensively discusses various aspects of cancer medication adherence that include therapeutic modalities for treating cancers, factors influencing medication adherence, barriers, and facilitators to medication adherence.
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Affiliation(s)
- Reshma V
- Pharmacology, Shri Sathya Sai Medical College and Research Institute (SSSMCRI), Chennai, IND
| | - Arun M Chacko
- Biochemistry, Sri Balaji Vidyapeeth, Puducherry, IND
- Biochemistry, Azeezia Institute of Medical Sciences and Research, Kollam, IND
| | - Naseeha Abdulla
- Pharmacology and Therapeutics, Kunhitharuvai Memorial Charitable Trust (KMCT) Medical College, Calicut, IND
| | - Maduram Annamalai
- Pharmacology, Shri Sathya Sai Medical College and Research Institute (SSSMCRI), Chennai, IND
| | - Venkataramana Kandi
- Clinical Microbiology, Prathima Institute of Medical Sciences, Karimnagar, IND
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Belitsi V, Tsiampalis T, Kouvari M, Kalantzi V, Androutsos O, Bonoti F, Panagiotakos DB, Kosti RI. Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece-The IACT-Study. Life (Basel) 2023; 13:1880. [PMID: 37763284 PMCID: PMC10532979 DOI: 10.3390/life13091880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Evidence has shown that poor adherence to vascular medications contributes to a considerable proportion of all cardiovascular disease (CVD) events and mortality. The aim of the present work was to examine patients' beliefs/views that affect their level of adherence to the assigned medical treatment in the context of a multi-center study in Greece. METHODS Between July 2022 and April 2023, 1988 patients (1180 females) with established cardiovascular disease or relevant cardiometabolic disorders were chosen from seven medical centers in Greece. The 4-item Morisky Medication Adherence Questionnaire gauged medication adherence and investigated patients' beliefs/views regarding treatment. RESULTS Among participants, 51.2% showed perfect medication adherence, contrasting with 48.8% displaying poor adherence. Patients with negative medication beliefs were around three times more likely to be non-adherent (OR = 2.73; 95% CI = 2.28-3.28). Non-adherers held concerns about drug efficacy (OR = 2.34; 95% CI = 1.10-4.97) and favored alternative therapies (OR = 2.25; 95% CI = 1.75-2.91). CONCLUSION The findings highlight the significance of addressing patient beliefs/views to improve medication adherence. The distinct Mediterranean context, influenced by cultural, socioeconomic, and clinical factors, emphasizes the need for tailored interventions. This underscores the call for contextually sensitive strategies to boost medication adherence and improve health outcomes in this unique region.
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Affiliation(s)
- Vasiliki Belitsi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Vasiliki Kalantzi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
| | - Fotini Bonoti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Rena I. Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
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Ozavci G, Bucknall T, Woodward‐Kron R, Hughes C, Jorm C, Manias E. Towards patient-centred communication in the management of older patients' medications across transitions of care: A focused ethnographic study. J Clin Nurs 2022; 31:3235-3249. [PMID: 34873761 PMCID: PMC9786755 DOI: 10.1111/jocn.16162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/08/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Communication about managing medications during transitions of care can be a challenging process for older patients since they often have complex medication regimens. Previous studies highlighted that links between communication breakdowns and medication incidents in older patients occur mainly at discharge or in the post-discharge period. Little attention has been paid to exploring communication strategies facilitating patient-centred medication communication at transitions of care from a discourse-analytic perspective. OBJECTIVES To explore, through a discursive lens, strategies that enable patient-centred medication communication at transitions of care. DESIGN A focused ethnographic study was employed for this study. The study was reported according to the COREQ checklist. METHODS Interviews, observations and focus groups were analysed utilising Critical Discourse Analysis and the Medication Communication Model following thematic analysis. Data collection was undertaken in eight wards across two metropolitan hospitals in Australia. RESULTS Patient preferences and beliefs about medications were identified as important characteristics of patient-centred communication. Strategies included empathetic talk prioritising patients' medication needs and preferences for medications; informative talk clarifying patients' concerns; and encouraging talk for enhancing shared decision-making with older patients. Challenges relating to the use of these strategies included patients' hearing, speech or cognitive impairments, language barriers and absence of interpreters or family members during care transitions. RELEVANCE TO CLINICAL PRACTICE To enhance medication communication, nurses, doctors and pharmacists should incorporate older patients' preferences, previous experiences and beliefs, and consider the challenges faced by patients across transitions. Strategies encouraging patients' contribution to decision-making processes are crucial to patient-centeredness in medication communication. Nurses need to engage in informative talk more frequently when administering the medications to ensure older patients' understanding of medications prescribed or altered in hospital settings.
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Affiliation(s)
- Guncag Ozavci
- Centre for Quality and Patient Safety ResearchThe School of Nursing and MidwiferyInstitute for Health TransformationAlfred HealthDeakin UniversityBurwoodVic.Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety ResearchThe School of Nursing and MidwiferyInstitute for Health TransformationAlfred HealthDeakin UniversityBurwoodVic.Australia
| | - Robyn Woodward‐Kron
- Department of Medical EducationMelbourne Medical SchoolThe University of MelbourneParkvilleVic.Australia
| | - Carmel Hughes
- School of PharmacyQueen's University BelfastBelfastUK
| | - Christine Jorm
- School of Public HealthThe University of SydneyCamperdownNSWAustralia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety ResearchThe School of Nursing and MidwiferyInstitute for Health TransformationAlfred HealthDeakin UniversityBurwoodVic.Australia
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Hall J, Kroll T, van Wijck F, Bassil-Morozow H. Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:877442. [PMID: 36189023 PMCID: PMC9397888 DOI: 10.3389/fresc.2022.877442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022]
Abstract
Background Stroke survivor narratives can provide valuable insight into experiences of healthcare and beyond. There is need to further understand collective lessons from stroke survivor narratives, yet prior studies utilizing digital storytelling tend to not synthesize lessons from individual experiences. This study aims to develop a novel method to co-create digital stories with stroke survivors that will aim to synthesize and portray important collective lessons from individual stroke survivors' experiences of interacting with healthcare professionals. Methods This study follows-up a qualitative study conducted with 30 stroke survivors exploring factors that help or hinder survivors to positively reconfigure their identity post-stroke. Five co-creation workshops were conducted with a subset of UK-based stroke survivors from this previous study. Participants were invited to join through: online workshops, an online bulletin board, and as an advisor. A four-stage workshop framework was developed through the integration of UK Design Council's Double Diamond method, digital storytelling strategies and the Behavior Change Wheel (BCW) framework for developing behavioral change interventions. Findings Six online workshop participants (three male, three female; aged 33–63; time since stroke 2–16 years) co-created digital stories that share six collective lessons aimed at increasing empathy and encouraging behavior change in healthcare professionals (HCPs) working with stroke survivors. Online bulletin board participants (n = 1) and advisors (n = 5) supported the co-creation process. Collective lessons identified were: (1) Stroke has a variety of symptoms that must all be considered; (2) Stroke can affect anyone of any age and not just the elderly; (3) Assumptions should not be made about a survivor's lifestyle or habits; (4) It is important to acknowledge the person behind the stroke and ensure that they are communicated with and listened to; (5) Stroke survivors can often feel unprepared for the reality of life after stroke; (6) Adapting to life after stroke is a long-term process requiring long-term support. Conclusion Stroke survivor stories highlighted preconceptions, attitudes and behaviors embedded within healthcare that negatively impacted their experiences and recovery. The novel methodology employed in this study enabled these stories to be synthesized into collective lessons to bring about improvements in these behaviors in future.
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Affiliation(s)
- Joseph Hall
- Department of Media and Journalism, Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
- *Correspondence: Joseph Hall
| | - Thilo Kroll
- UCD Centre for Education, Research and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin (UCD), Dublin, Ireland
| | - Frederike van Wijck
- Research Centre for Health, School for Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Helena Bassil-Morozow
- Department of Media and Journalism, Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
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Khettar S, Jacquin Courtois S, Luaute J, Decullier E, Bin S, Dupuis M, Derex L, Mechtouff L, Nighoghossian N, Dussart C, Rode G, Janoly-Dumenil A. Multiprofessional intervention to improve adherence to medication in stroke patients: a study protocol for a randomised controlled trial (ADMED AVC study). Eur J Hosp Pharm 2022; 29:169-175. [PMID: 32978218 PMCID: PMC9047932 DOI: 10.1136/ejhpharm-2020-002425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Adherence to secondary preventive medications is often suboptimal in patients with stroke, exposing them to an increased risk of recurrent cerebral and/or cardiovascular events. Effective actions in the long term to improve adherence to medication are needed. The study will evaluate the efficacy of a collaborative multiprofessional patient-centred intervention conducted by a pharmacist on adherence to secondary preventive medication in stroke survivors. METHODS AND ANALYSIS This is a multicentre cluster-randomised controlled trial. Two groups of 91 patients (intervention vs standard care) will be recruited. The clinical pharmacist intervention targeting secondary preventive medication will consist of three parts over 1 year: (1) an individual semi-structured interview at hospital discharge; (2) follow-up telephone interviews at 3, 6 and 9 months after discharge; and (3) a final individual semi-structured interview 1 year after discharge. Information on patient follow-up will be shared with the general practitioner and the community pharmacist by sending a report of each interview. The primary outcome is adherence to medication during the 12 months after hospital discharge, assessed using a composite endpoint: the medication possession ratio associated with a self-administered questionnaire. ETHICS AND DISSEMINATION The local ethics committee, the national committee for use of personal data in medical research and the national data protection agency approved the study. The sponsor has no role in study design; collection, analysis and interpretation of data; or report writing. DISCUSSION This pharmacist-led educational programme has the potential to significantly improve adherence to medication in stroke survivors which could lead to a decrease in recurrent cerebral and/or cardiovascular events. TRIAL REGISTRATION NUMBER NCT02611440.
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Affiliation(s)
- Sophie Khettar
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- EA 4129 P2S Parcours Santé Systémique, Claude Bernard University Lyon 1, Lyon, France
| | - Sophie Jacquin Courtois
- Physical medicine and rehabilitation department, Henry Gabrielle Hospital, Hospices Civils de Lyon, Saint-Genis-Laval, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, Claude Bernard University Lyon 1, Bron, France
| | - Jacques Luaute
- Physical medicine and rehabilitation department, Henry Gabrielle Hospital, Hospices Civils de Lyon, Saint-Genis-Laval, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, Claude Bernard University Lyon 1, Bron, France
| | - Evelyne Decullier
- Public Health Center, Research and Clinical Epidemiology, Hospices Civils de Lyon, Lyon, France
| | - Sylvie Bin
- Public Health Center, Research and Clinical Epidemiology, Hospices Civils de Lyon, Lyon, France
| | - Marine Dupuis
- Public Health Center, Research and Clinical Epidemiology, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- EA 7425 HESPER Health Services and Performance Research, Claude Bernard University Lyon1, Lyon, France
- Stroke center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Laura Mechtouff
- Stroke center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
- INSERM U1060, CarMeN laboratory, Claude bernard University Lyon 1, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
- INSERM U1044, CNRS UMR 5220, CREATIS, Claude Bernard University Lyon 1, Villeurbanne, France
| | - Claude Dussart
- EA 4129 P2S Parcours Santé Systémique, Claude Bernard University Lyon 1, Lyon, France
| | - Gilles Rode
- Physical medicine and rehabilitation department, Henry Gabrielle Hospital, Hospices Civils de Lyon, Saint-Genis-Laval, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, Claude Bernard University Lyon 1, Bron, France
| | - Audrey Janoly-Dumenil
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- EA 4129 P2S Parcours Santé Systémique, Claude Bernard University Lyon 1, Lyon, France
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Gibson J, Coupe J, Watkins C. Medication adherence early after stroke: using the Perceptions and Practicalities Framework to explore stroke survivors', informal carers' and nurses' experiences of barriers and solutions. J Res Nurs 2022; 26:499-514. [PMID: 35265156 PMCID: PMC8899295 DOI: 10.1177/1744987121993505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Secondary prevention medication after stroke reduces risk of recurrence, but adherence is often poor. Stroke survivors’, carers’ and nurses’ perspectives of early post-stroke medication adherence are unexplored. Aim The aim of this study was to explore stroke survivors’, carers’ and nurses’ views and experiences about adhering to medication early after post-stroke hospital discharge. Methods Qualitative individual and group interviews, utilising the Perceptions and Practicalities Framework, were employed. Nine people <2 months post-stroke, three carers and 15 nurses from one UK stroke unit participated. Interviews were digitally recorded, transcribed and thematically analysed. Results There were four main themes with two sub-themes. (1) Perceptions of medication taking after stroke. Factors affecting adherence included depression, imperceptible benefits and concerns about adverse effects. (2) Perceptions about those at higher risk of poor medication adherence. Nurses suggested that poor adherence might be more likely in those living alone or with previous non-adherence. (3) Practicalities of taking medication early after stroke; these included post-stroke disabilities, cognition, polypharmacy and lack of information. (4a) Practicalities of addressing poor medication adherence during the hospital stay. Solutions included multidisciplinary co-ordination, but nurses and stroke survivors described suboptimal use of opportunities to promote adherence. (4b) Practicalities of addressing poor medication adherence post-discharge. Solutions included modifications and support from carers, but stroke survivors reported difficulties in evolving systems for taking medications. Conclusions Stroke survivors and informal carers lack knowledge and support needed to manage medication early after discharge. Nurses’ opportunities to promote medication adherence are under-exploited. Medication adherence strategies to support stroke survivors early after discharge are needed.
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Affiliation(s)
- Josephine Gibson
- Reader in Health Services Research, School of Nursing, University of Central Lancashire, Preston, UK
| | - Jacqueline Coupe
- Research Associate, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Caroline Watkins
- Professor of Stroke and Older People's Care; Faculty Director of Research and Innovation, School of Nursing, University of Central Lancashire, Preston, UK
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Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research. Pharmaceutics 2021; 13:pharmaceutics13071100. [PMID: 34371791 PMCID: PMC8309154 DOI: 10.3390/pharmaceutics13071100] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Medication adherence continues to be a significant challenge in healthcare, and there is a shortage of effective interventions in this area. This scoping review studied the patient-related factors of medication adherence. Methods: We searched Medline Ovid, Scopus, and Cochrane Library from January 2009 to June 2021 to find the most recent original qualitative studies or systematic reviews that addressed the patient-related factors of medication adherence in treating chronic conditions. We used the PRISMA-ScR checklist to ensure the quality of the study. Results: The initial search revealed 4404 studies, of which we included 89 qualitative studies in the scoping review. We inductively organized the patient-related factors causing barriers, as well as the facilitators to medication adherence. The studies more often dealt with barriers than facilitators. We classified the factors as patient-specific, illness-specific, medication-related, healthcare and system-related, sociocultural, as well as logistical and financial factors. Information and knowledge of diseases and their treatment, communication, trust in patient-provider relationships, support, and adequate resources appeared to be the critical facilitators in medication adherence from the patient perspective. Discussion and conclusions: Patients are willing to discuss their concerns about medications. Better communication and better information on medicines appear to be among the critical factors for patients. The findings of this scoping review may help those who plan further interventions to improve medication adherence.
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Affiliation(s)
- Kirsi Kvarnström
- HUS Pharmacy, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
- Correspondence:
| | - Aleksi Westerholm
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
| | - Helena Liira
- Department of General Practice, University of Helsinki, 00290 Helsinki, Finland;
- Unit of Primary Health Care, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
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Shani SD, Sylaja PN, Sankara Sarma P, Raman Kutty V. Facilitators and barriers to medication adherence among stroke survivors in India. J Clin Neurosci 2021; 88:185-190. [PMID: 33992182 DOI: 10.1016/j.jocn.2021.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/21/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Strict compliance with medication and life style modification are integral to secondary stroke prevention. This study was undertaken to find out medication adherence among stroke survivors and factors associated with it. Cross sectional survey among stroke survivors was conducted. Interview based self-reported medication adherence was defined as consumption at least >80% of their medications for last two weeks, based on last prescription. Structured interview using pretested interview schedule was done to collect other data. Sequential step wise logistic regression analysis was done to find out the facilitators and barriers to medication adherence. Two hundred and forty stroke survivors (mean age 58.64 ± 10.96 years; 25.4% females) with a mean post-stroke period of 6.65 ± 3.36 months were participated. Overall medication adherence was 43.8% (n = 105). Medication adherence was 34.3% (n = 134), 52.6% (n = 190) and 56.7% (n = 224) for antidiabetics, antihypertensives and statins respectively and was associated with risk factor control (Diabetes: Odds Ratio (OR) = 4.85; 95% Confidence Interval (CI) 2.12-11.08, Hypertension: OR = 3.42; 95% CI 1.83-6.4, Dyslipidaemia: OR = 3.88; 95% CI 1.96-4.04). Having daily routine (OR = 2.82; 95% CI 1.52-5.25), perceived need of medication (OR = 2.33; 95% CI 1.04-5.2) and perceived poor state of health (OR = 2.65; 95% CI 1.30-5.40) were facilitators. Memory issues (OR = 0.34; 95% CI 0.16-0.71), side effects (OR = 0.24; 95% CI 0.11-0.42) and financial constraints (OR = 0.46; 95% CI 0.24-0.91) were barriers to medication adherence. Establishing daily routines, periodic reminders, financial supports to buy medicines and patient education can enhance medication adherence to prevent future strokes.
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Affiliation(s)
- S D Shani
- Achutha Menon Centre for Health Sciences Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala 695 011, India.
| | - P Sankara Sarma
- Achutha Menon Centre for Health Sciences Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - V Raman Kutty
- Research Director, Amala Cancer Research Centre, Thrissur 680555, India
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Stroke patients' support: evaluation of knowledge, practices and training needs of French community pharmacists. Int J Clin Pharm 2021; 43:980-989. [PMID: 33387187 DOI: 10.1007/s11096-020-01204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
Background Stroke represents a major Public Health issue in industrialized countries because of its frequency and severity. In secondary stroke prevention, treatment efficacy is correlated to medication adherence. However, it remains suboptimal in stroke patients. Community pharmacists, in light of their positioning in the care pathway and proximity to patients, can play an essential role in patient support and improving treatment adherence. However, it is currently unknown whether pharmacists are ready to perform this task. Objective Evaluate knowledge, practices and training needs for community pharmacists in therapeutic stroke management to improve long term care for stroke patients. Setting Community pharmacies in the Rhone Alpes region (France). Method We conducted a cross sectional study via a standardized self-assessment questionnaire consisting of 40 questions divided into three parts. The latter was designed by a multidisciplinary team and distributed electronically to community pharmacists of the Rhône-Alpes region (France). Main outcome measure (a) global knowledge score on the pathology, risk factors and clinical care management, (b) description of the support practices for stroke patients, (c) training needs for pharmacists. Results The 104 participants presented a moderate level of knowledge (global score: 12/20 ± 3). Topics best mastered were: pathophysiology, target blood pressure and place of antiplatelets in the therapeutic strategy. Knowledge items that needed improvement were: warning signs correctly identified by 44% of participants, time delay for thrombolysis for which 14% answered correctly, target glycated hemoglobin levels were correct for 41%, and the 3 recommended antihypertensive drug classes were only identified by 5% of participants. Patient education received from pharmacists concerned dosage (89%), treatment adherence (88%), benefits (66%) and administration modalities of medicines (64%), management of risk factors (75% for diet, 73% for physical activity, 70% for smoking and 53% for alcohol). All pharmacists wanted additional training on risk factors and clinical management guidelines. Conclusion Based on this small study, the fragmented knowledge and varied practices promote the need for further training for pharmacists to optimize support of stroke patients. This study promotes the elaboration of training systems adapted to pharmacists' needs. This will help support the development of a targeted pharmaceutical care approach for stroke patients.
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Medication adherence for secondary stroke prevention and its barriers among lebanese survivors: A cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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The Medication Experience: A Concept Analysis. PHARMACY 2020; 9:pharmacy9010007. [PMID: 33396387 PMCID: PMC7839002 DOI: 10.3390/pharmacy9010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
This is a concept analysis of the medication experience with a focus on how it applies to the pharmaceutical care practice framework used by pharmacist practitioners. The medication experience is a vital component of pharmaceutical care practice and of patient-centered care. Although the experience of taking medication has been studied across disciplines for decades, a concept analysis of the medication experience is lacking. Rodgers’ evolutionary concept analysis method was utilized. Ovid Medline, CINAHL, PsycINFO, Sociological Abstracts and Google Scholar databases, references and hand searches were used to compile an international dataset of 66 papers published from 1982 to 2020. As a result of the available literature, the medication experience is defined as one of ambivalence and vulnerability in which the patient is actively engaged in an ongoing process or negotiation, which is pragmatic to the ways in which they live and experience life, contextualized and nuanced within the social construction of their individual realities. The concept of medication experience is an important addition to the scientific literature. The definition of medication experience from the perspective of the patient will help to better explain the concept for future research and theory development to move the discipline of pharmaceutical care practice forward.
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Viprey M, Gouillet M, Puppo C, Termoz A, Della Vecchia C, Derex L, Haesebaert J, Schott AM, Préau M. A Qualitative Study of Barriers and Facilitators to Adherence to Secondary Prevention Medications Among French Patients Suffering from Stroke and Transient Ischemic Attack. Patient Prefer Adherence 2020; 14:1213-1223. [PMID: 32801652 PMCID: PMC7382755 DOI: 10.2147/ppa.s257323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/23/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Secondary prevention medications (SPM) reduce the risk of ischemic stroke (IS) and transient ischemic attack (TIA) recurrence. However, approximately one-third of patients are estimated to be non-adherent. This qualitative study aimed to explore barriers and facilitators to adherence to SPM after IS or TIA. PATIENTS AND METHODS Thirty-six face-to-face semi-structured interviews were conducted with 14 TIA patients and 22 IS patients who self-administered their treatment 12 months after IS/TIA. A thematic analysis was performed. RESULTS Major facilitators to good adherence to SPM were the fear of stroke recurrence and the high level of trust in the prescribing physician. Barriers included a perceived lack and/or inappropriate timing of information about SPM, practical difficulties of taking some SPM (eg, inadequate packaging) and of implementing routines into their daily life. CONCLUSION Information on SPM is inadequate in terms of quantity and timing both during the acute IS/TIA period and over the long term. Providing more tailor-made information at an opportune moment, in particular by promoting discussion with their general practitioner (GP) throughout the course of illness and recovery, is essential to ensure that patients are not left alone in the decision-making process regarding adherence to SPM.
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Affiliation(s)
- Marie Viprey
- Public Health Department, Hospices Civils de Lyon, Lyon, France
- HESPER EA 7425, University of Lyon, University Claude Bernard Lyon 1, Lyon, France
| | | | | | - Anne Termoz
- Public Health Department, Hospices Civils de Lyon, Lyon, France
- HESPER EA 7425, University of Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Claire Della Vecchia
- HESPER EA 7425, University of Lyon, University Claude Bernard Lyon 1, Lyon, France
- GRePS, Lyon 2 University, Lyon, France
| | - Laurent Derex
- HESPER EA 7425, University of Lyon, University Claude Bernard Lyon 1, Lyon, France
- Comprehensive Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Julie Haesebaert
- Public Health Department, Hospices Civils de Lyon, Lyon, France
- HESPER EA 7425, University of Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Anne-Marie Schott
- Public Health Department, Hospices Civils de Lyon, Lyon, France
- HESPER EA 7425, University of Lyon, University Claude Bernard Lyon 1, Lyon, France
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Gibson JME, Miller C, Coupe J, Jones SP. Medication-taking after stroke: a qualitative meta-synthesis of the perspectives of stroke survivors, informal carers and health professionals. Fam Pract 2020; 37:4-14. [PMID: 31324915 DOI: 10.1093/fampra/cmz030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lifelong secondary prevention medication is recommended after stroke or transient ischaemic attack. However, poor medication adherence and persistence, which lead to suboptimal health outcomes, are common, but the reasons for this are not well understood, mainly because there have been few studies reporting adherence barriers in stroke survivors. OBJECTIVE The aim of this review was to undertake a meta-synthesis of qualitative studies of medication-taking after stroke. Outcomes of interest were: lived experiences, views and beliefs, and strategies and solutions used by community-dwelling stroke and transient ischaemic attack survivors, informal carers and health care professionals in relation to medication-taking. METHOD The review protocol was registered on PROSPERO (CRD42018086792). A search of online bibliographic databases was performed using key search terms of stroke, persistence, adherence and medication for years 1980-2018. Citation tracking was also carried out. Studies using qualitative or mixed methods were included. Systematic data extraction and synthesis were conducted using a meta-ethnographic approach. RESULTS Twelve studies were eligible for inclusion, with a total of 412 participants, two-thirds of whom were stroke survivors, ranging from 1 month to over 20 years post-stroke. Third-order themes identified were 'Medicines Work'-Information Work; Health Care Work; Carer Work; Emotional Work; Practical Work and an underpinning theme of Trust. However, many studies had significant methodological weaknesses. CONCLUSIONS This synthesis suggests that the burden of 'medicines work' after stroke is substantial and multifaceted. Its successful undertaking depends on mutual trust between stroke survivors, carers and health care professionals and trust in the benefits of medicines themselves.
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Affiliation(s)
| | - Colette Miller
- School of Nursing, University of Central Lancashire, Preston, UK
| | - Jacqueline Coupe
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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Appalasamy JR, Subramanian P, Tan KM, Seeta Ramaiah S, Joseph JP, Chua SS. The Needs and Barriers of Medication-Taking Self-Efficacy Among Poststroke Patients: Qualitative Study. JMIR Nurs 2019; 2:e14399. [PMID: 34345772 PMCID: PMC8279437 DOI: 10.2196/14399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/09/2019] [Accepted: 06/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background Stroke is one of the top 10 leading diseases worldwide, with high mortality and morbidity rates. There is an incomplete understanding of the various types of self-efficacy involved in the prevention of recurrent stroke, and one of them is medication-taking self-efficacy. Objective This study aimed to explore the fundamental needs and barriers of medication-taking self-efficacy in poststroke patients in Malaysia. Methods We performed in-depth individual interviews with poststroke patients (N=10) from the Outpatient Neurology Clinic, Hospital Kuala Lumpur. All interviews were transcribed verbatim, and an inductive thematic analysis was performed on the data collected from the interviews. Results Two key themes were identified: (1) self-efficacy in taking the effort to understand stroke and its preventative treatment for recurrent stroke and (2) self-efficacy in taking prescribed medication to prevent stroke. Patients needed to be proactive in seeking reliable information about stroke and the perceived benefits of preventative treatment for stroke. The discussion was focused on eliciting the needs and barriers related to medication-taking self-efficacy. Patients needed to develop independence and self-reliance to overcome barriers such as dependency and low motivation. External factors such as limited information resources, low perceived severity, poor social environment, and poor communication add to the challenges of poststroke patients to improve their self-efficacy of managing their medications. Conclusions The study identified potential key findings related to the needs of patients in a localized setting, which are also related to several health behavioral concepts and constructs, indicating the importance of overcoming barriers to improve the quality of life in poststroke patients. We anticipate that the results will be taken into consideration for future personalized patient education interventions.
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Affiliation(s)
- Jamuna Rani Appalasamy
- Jeffrey Cheah School of Medicine and Health Sciences Monash University Bandar Sunway Malaysia
| | | | - Kit Mun Tan
- Department of Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | | | | | - Siew Siang Chua
- Faculty of Health & Medical Sciences Taylor's University Subang Jaya Malaysia
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DaCosta D, Dodds LJ, Corlett SA. Development of a tool to support person-centred medicine-focused consultations with stroke survivors. PATIENT EDUCATION AND COUNSELING 2019; 102:1263-1272. [PMID: 30765119 DOI: 10.1016/j.pec.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/25/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To develop a tool to support medicine-focused person-centred consultations between community pharmacists and stroke survivors. METHOD Semi-structured interviews with 15 stroke survivors and 16 community pharmacists were conducted. Thematic analysis of the data was performed and emerging themes examined to determine their relevance to the principles of delivering person-centred care. Findings were used to generate a framework from which a consultation tool was created. Face validity and the feasibility of using the tool in practice were explored with participating pharmacists. RESULTS Three major themes were identified; personal, process and environmental factors. A tool, in two parts, was developed, A 'Getting to know me' form which would help the pharmacist to appreciate the individual needs of the stroke survivor and a consultation guide to facilitate the consultation process. Pharmacists considered that both were useful and would support a person-centred medicine-focussed consultation. CONCLUSION A consultation tool, reflecting the needs of stroke survivors, has been developed and is feasible for use within community pharmacy practice. PRACTICE IMPLICATIONS Pharmacists must recognise the individual needs of stroke survivors to ensure that they provide consultations which are truly person-centred. The tool developed could support medicine-related consultations with patients with other long term conditions.
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Affiliation(s)
- Daniel DaCosta
- Medway School of Pharmacy, Universities of Kent and Greenwich at Medway, Chatham Maritime, Kent, ME4 4TB, United Kingdom
| | - Linda J Dodds
- Medway School of Pharmacy, Universities of Kent and Greenwich at Medway, Chatham Maritime, Kent, ME4 4TB, United Kingdom
| | - Sarah A Corlett
- Medway School of Pharmacy, Universities of Kent and Greenwich at Medway, Chatham Maritime, Kent, ME4 4TB, United Kingdom.
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Jamison J, Sutton S, Mant J, De Simoni A. Online stroke forum as source of data for qualitative research: insights from a comparison with patients' interviews. BMJ Open 2018; 8:e020133. [PMID: 29602848 PMCID: PMC5884329 DOI: 10.1136/bmjopen-2017-020133] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To determine the appropriateness of an online forum compared with face-to-face interviews as a source of data for qualitative research on adherence to secondary prevention medications after stroke. DESIGN A comparison of attributes of two data sources, interviews and a forum, using realistic evaluation; a comparison of themes around adherence according to the Perceptions and Practicalities Approach (PAPA) framework. SETTING Interviews were conducted in UK GP practices in 2013 and 2014; online posts were written by UK stroke survivors and family members taking part in the online forum of the Stroke Association between 2004 and 2011. PARTICIPANTS 42 interview participants: 28 stroke survivors (age range 61-92 years) and 14 caregivers (85% spouses). 84 online forum participants: 49 stroke survivors (age range 32-72 years) and 33 caregivers (60% sons/daughters). RESULTS 10 attributes were identified within the two data sources and categorised under three domains (context, mechanisms and outcomes). Participants' characteristics of forum users were often missing. Most forum participants had experienced a stroke within the previous 12 months, while interviewees had done so 1-5 years previously.All interview themes could be matched with corresponding themes from the forum. The forum yielded three additional themes: influence of bad press on taking statins, criticisms of clinicians' prescribing practices and caregiver burden in assisting with medications and being advocates for survivors with healthcare professionals. CONCLUSIONS An online forum is an appropriate source of data for qualitative research on patients' and caregivers' issues with adherence to secondary prevention stroke medications and may offer additional insights compared with interviews, which can be attributed to differences in the approach to data collection.
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Affiliation(s)
- James Jamison
- Primary Care Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Stephen Sutton
- Primary Care Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anna De Simoni
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Jamison J, Ayerbe L, Di Tanna GL, Sutton S, Mant J, De Simoni A. Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: a survey. BMJ Open 2018; 8:e019874. [PMID: 29526835 PMCID: PMC5855212 DOI: 10.1136/bmjopen-2017-019874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To design a questionnaire and use it to explore unmet needs with practical aspects of medicine taking after stroke, predictors of medicine taking and to estimate the proportion of survivors who get support with daily medication taking. DESIGN Four workshops with stroke survivors and caregivers to design the questionnaire.A cross-sectional postal questionnaire in primary care. SETTING 18 general practitioner practices in the East of England and London. Questionnaires posted between September 2016 and February 2017. PARTICIPANTS 1687 stroke survivors living in the community outside institutional long-term care. PRIMARY OUTCOME MEASURES The proportion of community stroke survivors receiving support from caregivers for practical aspects of medicine taking; the proportion with unmet needs in this respect; the predictors of experiencing unmet needs and missing taking medications. RESULTS A five-item questionnaire was developed to cover the different aspects of medicine taking. 596/1687 (35%) questionnaires were returned. 56% reported getting help in at least one aspect of taking medication and 11% needing more help. 35% reported missing taking their medicines. Unmet needs were associated with receiving help with medications (OR 5.9, P<0.001), being on a higher number of medications (OR 1.2, P<0.001) and being dependent for activities of daily living (OR 4.9, P=0.001). Missing medication was associated with having unmet needs (OR 5.3, P<0.001), receiving help with medications (OR 2.1, P<0.001), being on a higher number of medicines (OR 1.1, P=0.008) and being older than 70 years (OR 0.6, P=0.006). CONCLUSIONS More than half of patients who replied needed help with taking medication, and 1 in 10 had unmet needs in this regard. Stroke survivors dependent on others have more unmet needs, are more likely to miss medicines and might benefit from focused clinical and research attention. Novel primary care interventions focusing on the practicalities of taking medicines are warranted.
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Affiliation(s)
- James Jamison
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Luis Ayerbe
- Centre for Primary Care and Public Health, Barts, The London School of Medicine and Dentistry, London, UK
| | - Gian Luca Di Tanna
- Centre for Primary Care and Public Health, Barts, The London School of Medicine and Dentistry, London, UK
| | - Stephen Sutton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Anna De Simoni
- Centre for Primary Care and Public Health, Barts, The London School of Medicine and Dentistry, London, UK
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Pindus DM, Mullis R, Lim L, Wellwood I, Rundell AV, Abd Aziz NA, Mant J. Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography. PLoS One 2018; 13:e0192533. [PMID: 29466383 PMCID: PMC5821463 DOI: 10.1371/journal.pone.0192533] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/25/2018] [Indexed: 11/28/2022] Open
Abstract
Objective To describe and explain stroke survivors and informal caregivers’ experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services. Design Systematic review and meta-ethnography. Data sources Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015). Eligibility criteria Primary qualitative studies focused on adult community-dwelling stroke survivors’ and/or informal caregivers’ experiences of primary care and/or community healthcare services. Data synthesis A set of common second order constructs (original authors’ interpretations of participants’ experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods’ criteria. Results 51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke. Limitations Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems. Conclusions Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services. Systematic review registration number PROSPERO 2015:CRD42015026602
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Affiliation(s)
- Dominika M. Pindus
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Ricky Mullis
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Lisa Lim
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Ian Wellwood
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - A. Viona Rundell
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Noor Azah Abd Aziz
- Department of Family Medicine, National University of Malaysia, Bandar Tun Razak Cheras, Kuala Lumpur, Malaysia
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
- * E-mail:
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Izuka NJ, Alexander MAW, Balasooriya-Smeekens C, Mant J, De Simoni A. How do stroke survivors and their carers use practitioners' advice on secondary prevention medications? Qualitative study of an online forum. Fam Pract 2017; 34:612-620. [PMID: 28398553 DOI: 10.1093/fampra/cmx023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Secondary prevention medications reduce risk of stroke recurrence, yet many people do not receive recommended treatment, nor take medications optimally. OBJECTIVE Exploring how patients report making use of practitioners' advice on secondary prevention medicines on an online forum and what feedback was received from other participants. METHODS Thematic analysis of the archive of Talkstroke (2004-2011), UK. Posts including any secondary prevention medication terms, General Practitioner (GP) and their replies were identified. RESULTS Fifity participants talked about practitioners' advice on secondary prevention medications in 43 discussion threads. Patients consulted practitioners for reassurance and dealing with side effects. Practitioners' advice varied from altering to maintaining current treatment. Three main themes emerged from the use of practitioners' advice: patients following advice (reassured, happy when side effects made tolerable, or still retaining anxiety about treatment); patients not following advice (admitting adherence on-off or stopping medications as side effects still not tolerable); asking other participants for feedback on advice received. Practitioners' advice was disregarded mainly when related to dealing with statin side effects, after one or two consultations. Themes for feedback involved sharing experience, directing back to practitioners, or to external evidence. CONCLUSIONS Side effects of secondary prevention medications and statins in particular, cause anxiety and resentment in some patients, and their concerns are not always addressed by practitioners. Practitioners could consider more proactive strategies to manage such side effects. Forum feedback was appropriate and supportive of the practitioners' advice received. Our findings from peer-to-peer online conversations confirm and widen previous research.
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Affiliation(s)
- Nkeonye J Izuka
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, QMUL, London E1 2AB, UK
| | - Matthew A W Alexander
- Primary Care Unit, Department of Public Health, University of Cambridge School of Clinical Medicine, Cambridge CB1 8RN, UK
| | - Chantal Balasooriya-Smeekens
- Primary Care Unit, Department of Public Health, University of Cambridge School of Clinical Medicine, Cambridge CB1 8RN, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health, University of Cambridge School of Clinical Medicine, Cambridge CB1 8RN, UK
| | - Anna De Simoni
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, QMUL, London E1 2AB, UK
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Jamison J, Sutton S, Mant J, Simoni AD. Barriers and facilitators to adherence to secondary stroke prevention medications after stroke: analysis of survivors and caregivers views from an online stroke forum. BMJ Open 2017; 7:e016814. [PMID: 28713074 PMCID: PMC5541606 DOI: 10.1136/bmjopen-2017-016814] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To identify barriers and facilitators of medication adherence in patients with stroke along with their caregivers. DESIGN Qualitative thematic analysis of posts about secondary prevention medications, informed by Perceptions and Practicalities Approach. SETTING Posts written by the UK stroke survivors and their family members taking part in the online forum of the Stroke Association, between 2004 and 2011. PARTICIPANTS 84 participants: 49 stroke survivors, 33 caregivers, 2 not stated, identified using the keywords 'taking medication', 'pills', 'size', 'side-effects', 'routine', 'blister' as well as secondary prevention medication terms. RESULTS Perceptions reducing the motivation to adhere included dealing with medication side effects, questioning doctors' prescribing practices and negative publicity about medications, especially in regard to statins. Caregivers faced difficulties with ensuring medications were taken while respecting the patient's decisions not to take tablets. They struggled in their role as advocates of patient's needs with healthcare professionals. Not experiencing side effects, attributing importance to medications, positive personal experiences of taking tablets and obtaining modification of treatment to manage side effects were facilitators of adherence. Key practical barriers included difficulties with swallowing tablets, dealing with the burden of treatment and drug cost. Using medication storage devices, following routines and getting help with medications from caregivers were important facilitators of adherence. CONCLUSIONS An online stroke forum is a novel and valuable resource to investigate use of secondary prevention medications. Analysis of this forum highlighted significant barriers and facilitators of medication adherence faced by stroke survivors and their caregivers. Addressing perceptual and practical barriers highlighted here can inform the development of future interventions aimed at improving adherence to secondary prevention medication after stroke.
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Affiliation(s)
- James Jamison
- Primary Care Unit, Department of Public Health and Primary Care, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Stephen Sutton
- Primary Care Unit, Department of Public Health and Primary Care, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anna De Simoni
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Souter C, Kinnear A, Kinnear M, Mead G. A pilot study to assess the practicality, acceptability and feasibility of a randomised controlled trial to evaluate the impact of a pharmacist complex intervention on patients with stroke in their own homes. Eur J Hosp Pharm 2017; 24:101-106. [PMID: 31156913 PMCID: PMC6451612 DOI: 10.1136/ejhpharm-2016-000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/28/2016] [Accepted: 07/05/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To test the practicality, acceptability and feasibility of recruitment, data collection, blood pressure (BP) monitoring and pharmaceutical care processes, in order to inform the design of a definitive randomised controlled trial of a pharmacist complex intervention on patients with stroke in their own homes. METHODS Patients with new stroke from acute, rehabilitation wards and a neurovascular clinic (NVC) were randomised to usual care or to an intervention group who received a home visit at 1, 3 and 6 months from a clinical pharmacist. Pharmaceutical care comprised medication review, medicines and lifestyle advice, pharmaceutical care issue (PCI) resolution and supply of individualised patient information. A pharmaceutical care plan was sent to the General Practitioner and Community Pharmacy. BP and lipids were measured for both groups at baseline and at 6 months. Questionnaires covering satisfaction, quality of life and medicine adherence were administered at 6 months. RESULTS Of the 430 potentially eligible patients, 30 inpatients and 10 NVC outpatients were recruited. Only 33/364 NVC outpatients (9.1%) had new stroke. 35 patients completed the study (intervention=18, usual care=17). Questionnaire completion rates were 91.4% and 84.4%, respectively. BP and lipid measurement processes were unreliable. From 104 identified PCIs, 19/23 recommendations (83%) made to general practitioners were accepted. CONCLUSION Modifications to recruitment is required to include patients with transient ischaemic attack. Questionnaire response rates met criteria but completion rates did not, which merits further analysis. Lipid measurements are not necessary as an outcome measure. A reliable BP-monitoring process is required.
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Affiliation(s)
- Caroline Souter
- NHS Lothian Pharmacy Service, Western General Hospital and Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland
| | - Anne Kinnear
- NHS Lothian Pharmacy Service, Royal Infirmary of Edinburgh and Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Moira Kinnear
- NHS Lothian Pharmacy Service, Western General Hospital and Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland
| | - Gillian Mead
- Medicine of the Elderly Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
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GPs' perspectives on secondary cardiovascular prevention in older age: a focus group study in the Netherlands. Br J Gen Pract 2016; 65:e739-47. [PMID: 26500321 DOI: 10.3399/bjgp15x687373] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Although guidelines recommend secondary cardiovascular prevention irrespective of age, in older age the uptake of treatment is lower than in younger age groups. AIM To explore the dilemmas GPs in the Netherlands encounter when implementing guidelines for secondary cardiovascular prevention in older age. DESIGN AND SETTING Qualitative study in four focus groups consisting of GPs (n = 23, from the northern part of the province South Holland) and a fifth focus group consisting of GP trainees (n = 4, from the Leiden University Medical Center). METHOD Focus group discussions were organised to elicit perspectives on the implementation of secondary cardiovascular prevention for older people. The 14 theoretical domains of the refined Theoretical Domains Framework (TDF) were used for (deductive) coding of the focus group discussions. The coded texts were analysed, content was discussed, and barriers and facilitators were identified for each domain of the TDF. RESULTS The main theme that emerged was 'uncertainty'. Identified barriers were guideline-related, patient-related, and organisation-related. Identified facilitators were doctor-related, patient-related, and organisation-related. The main aim of secondary preventive treatment was improvement in quality of life. CONCLUSION GPs in the Netherlands are uncertain about many aspects of secondary cardiovascular prevention in older age; the guidelines themselves, their own role, patient factors, and the organisation of care. In view of this uncertainty, GPs consciously weigh all aspects of the situation in close dialogue with the individual patient, with the ultimate aim of improving quality of life. This highly-individualised care may largely explain the reduced prescription rates.
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Barriers to medication adherence for the secondary prevention of stroke: a qualitative interview study in primary care. Br J Gen Pract 2016; 66:e568-76. [PMID: 27215572 PMCID: PMC4979933 DOI: 10.3399/bjgp16x685609] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/09/2016] [Indexed: 02/07/2023] Open
Abstract
Background Medications are highly effective at reducing risk of recurrent stroke, but success is influenced by adherence to treatment. Among survivors of stroke and transient ischaemic attack (TIA), adherence to medication is known to be suboptimal. Aim To identify and report barriers to medication adherence for the secondary prevention of stroke/TIA. Design and setting A qualitative interview study was conducted within general practice surgeries in the East of England, UK. Method Patients were approached by letter and invited to take part in a qualitative research study. Semi-structured interviews were undertaken with survivors of stroke, caregivers, and GPs to explore their perspectives and views around secondary prevention and perceived barriers to medication adherence. Key themes were identified using a grounded theory approach. Verbatim quotes describing the themes are presented here. Results In total, 28 survivors of stroke, including 14 accompanying caregivers and five GPs, were interviewed. Two key themes were identified. Patient level barriers included ability to self-care, the importance people attach to a stroke event, and knowledge of stroke and medication. Medication level barriers included beliefs about medication and beliefs about how pills work, medication routines, changing medications, and regimen complexity and burden of treatment. Conclusion Patients who have had a stroke are faced with multiple barriers to taking secondary prevention medications in UK general practice. This research suggests that a collaborative approach between caregivers, survivors, and healthcare professionals is needed to address these barriers and facilitate medication-taking behaviour.
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Urbonas G, Kubilienė L, Kubilius R, Urbonienė A. Assessing the effects of pharmacists' perceived organizational support, organizational commitment and turnover intention on provision of medication information at community pharmacies in Lithuania: a structural equation modeling approach. BMC Health Serv Res 2015; 15:82. [PMID: 25885819 PMCID: PMC4349466 DOI: 10.1186/s12913-015-0741-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 02/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background As a member of a pharmacy organization, a pharmacist is not only bound to fulfill his/her professional obligations but is also affected by different personal and organizational factors that may influence his/her behavior and, consequently, the quality of the services he/she provides to patients. The main purpose of the research was to test a hypothesized model of the relationships among several organizational variables, and to investigate whether any of these variables affects the service of provision of medication information at community pharmacies. Methods During the survey, pharmacists working at community pharmacies in Lithuania were asked to express their opinions on the community pharmacies at which they worked and to reflect on their actions when providing information on medicines to their patients. The statistical data were analyzed by applying a structural equation modeling technique to test the hypothesized model of the relationships among the variables of Perceived Organizational Support, Organizational Commitment, Turnover Intention, and Provision of Medication Information. Results The final model revealed that Organizational Commitment had a positive direct effect on Provision of Medication Information (standardized estimate = 0.27) and a negative direct effect (standardized estimate = −0.66) on Turnover Intention. Organizational Commitment mediated the indirect effects of Perceived Organizational Support on Turnover Intention (standardized estimate = −0.48) and on Provision of Medication Information (standardized estimate = 0.20). Pharmacists’ Turnover Intention had no significant effect on Provision of Medication Information. Conclusions Community pharmacies may be viewed as encouraging, to some extent, the service of provision of medication information. Pharmacists who felt higher levels of support from their organizations also expressed, to a certain extent, higher commitment to their organizations by providing more consistent medication information to patients. However, the effect of organizational variables on the variable of Provision of Medication Information appeared to be limited.
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Affiliation(s)
- Gvidas Urbonas
- Department of Social Sciences and Humanities, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Loreta Kubilienė
- Department of Drug Technology and Social Pharmacy, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Raimondas Kubilius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Aušra Urbonienė
- Department of Philosophy and Psychology, Kaunas University of Technology, Kaunas, Lithuania.
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Bushnell C, Arnan M, Han S. A new model for secondary prevention of stroke: transition coaching for stroke. Front Neurol 2014; 5:219. [PMID: 25386161 PMCID: PMC4209826 DOI: 10.3389/fneur.2014.00219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/09/2014] [Indexed: 11/24/2022] Open
Abstract
Non-adherence to stroke prevention medications is a risk factor for first-ever and recurrent stroke. As of yet, there are no guidelines for processes to recognize and address medication non-adherence in stroke patients. We developed a new model of post-discharge prevention care that measures and addresses medication-taking (transition coaching for stroke or TRACS). TRACS includes personalized education about risk factors and medications prior to discharge, follow-up telephone calls, and appointments with a stroke nurse practitioner (NP). The stroke NP asks about medication use (persistence) and whether doses are missed (adherence), and helps to solve problems with access to medications or side effects. In an analysis of 142 patients enrolled in TRACS from October 2012 to February 2014, medication persistence (use of medications from discharge to the time of measurement) was about 80%. Medication persistence at NP visit was higher in those patients with a first-ever stroke (78.9%) vs. those with recurrent stroke (60.7%; p = 0.045). Concerted efforts with 2-day RN follow-up calls and earlier NP appointments to improve medication-taking behaviors are underway.
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Affiliation(s)
- Cheryl Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Martinson Arnan
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Sangwon Han
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
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