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Yu N, Yang J, Katas H. Using status of secondary prevention medications in post-stroke dysphagia patients: time to raise awareness and develop special formulations. Sci Rep 2024; 14:15377. [PMID: 38965353 PMCID: PMC11224274 DOI: 10.1038/s41598-024-66407-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024] Open
Abstract
Post-stroke dysphagia (PSD) is an increasingly common complication of stroke. Despite its intuitively unfavorable impact on secondary prevention medication use, limited awareness is available regarding this issue. Herein, a cross-sectional survey was conducted to determine the current use, patient-perceived needs and preferences for secondary prevention medications among PSD patients. To emphasize the unique context related to dysphagia, we recruited Chinese stroke patients with a duration of less than 5 years. These patients were initially categorized into PSD respondents with and without dysphagia. Among the 3490 eligible respondents, 42.7% reported experiencing dysphagia after stroke. Those PSD respondents were more likely to consume multiple medications and suffer from anticoagulants-associated gastrointestinal bleeding as compared to non-PSD ones (p < 0.001). More crucially, 40.2% of them had frequent difficulty in swallowing pills, 37.1% routinely crushed solid oral dosage forms (SODFs), and 23.5% coughed frequently when taking SODFs. In consequence, 87.4% responded a need for PSD-specific formulations where safe swallowing, easy swallowing, and reduced medication frequency were preferred pharmaceutical factors. These findings demonstrate an unsatisfactory situation and definite needs for PSD patients in using secondary prevention medications. Awareness should be increased to develop PSD-specific formulations for safe and effective secondary prevention.
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Affiliation(s)
- Na Yu
- Centre for Drug Delivery Technology and Vaccine (Centric), Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
- Department of Pharmaceutical Preparation, General Hospital of Ningxia Medical University, No. 804, Shengli South Street, Yinchuan, 750004, China
| | - Jianhong Yang
- School of Pharmacy, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Haliza Katas
- Centre for Drug Delivery Technology and Vaccine (Centric), Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia.
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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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Cao W, Wang J, Wang Y, Hassan II, Kadir AA. mHealth App to improve medication adherence among older adult stroke survivors: Development and usability study. Digit Health 2024; 10:20552076241236291. [PMID: 38465293 PMCID: PMC10921861 DOI: 10.1177/20552076241236291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Background Effective medication adherence is vital for older adult stroke survivors, yet 20-33% cease treatment within a year post-discharge, increasing risks of recurrent strokes and mortality. A mobile health (mHealth) app could be a novel tool to improve medication adherence among stroke survivors because of its potential to increase patient empowerment. A few stroke-related apps provide information and support to stroke survivors. However, none have focused on medication adherence and documented their development and evaluation process, particularly those focused on this older population. Objective This study aims to design and develop a smartphone app called OASapp to improve medication adherence among older adult stroke survivors and evaluate its usability. Methods OASapp was developed in a three-phase development process. Phase 1 is the exploration phase (including a cross-sectional survey, a systematic review, a search for stroke apps on the app stores of Apple App Store and Google Play Store, and a nominal group technique). In phase 2, a prototype was designed based on the Health Belief Model and Technology Acceptance Model. In phase 3, Alpha and Beta testing was conducted to validate the app. Results Twenty-five features for inclusion in the app were collected in round one, and 14 features remained and were ranked by the participants during nominal group technique. OASapp included five core components (medication management, risk factor management, health information, communication, and stroke map). Users of OASapp were satisfied based on reports from Alpha and Beta testing. The mean Usability Metric for User Experience (UMUX) score was 71.4 points (SD 14.6 points). Conclusion OASapp was successfully developed using comprehensive, robust, and theory-based methods and was found to be highly accepted by users. Further research is needed to establish the clinical efficacy of the app so that it can be utilized to improve clinically relevant outcomes.
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Affiliation(s)
- Wenjing Cao
- Xiangnan University, Chenzhou, Hunan Province, China
- School of Health Sciences, Universiti Sains Malaysia, Kota Baru, Kelantan, Malaysia
| | - Juan Wang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Yuhui Wang
- Central South University, Changsha, Hunan Province, China
| | - Intan Idiana Hassan
- School of Health Sciences, Universiti Sains Malaysia, Kota Baru, Kelantan, Malaysia
| | - Azidah Abdul Kadir
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Wang W, Pucciarelli G, Mei Y, Zhang Z, Vellone E. The dyadic self-care experience of stroke survivors and their caregivers: A qualitative descriptive study. Health Expect 2023; 26:2325-2339. [PMID: 37497863 PMCID: PMC10632628 DOI: 10.1111/hex.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/11/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Promoting self-care is the core response strategy of the global health system to the burden of stroke. Although self-care in stroke represents a dyadic phenomenon, the dyadic self-care experience of stroke survivors and their caregivers is often overlooked in clinical practice. OBJECTIVES The aim of this study was to explore the dyadic self-care experience of stroke survivors and their caregivers. DESIGN A descriptive qualitative design was used to conduct the study. RESULTS The Consolidated Criteria for Reporting Qualitative Research was used for study reporting. A total of 21 stroke survivor-caregiver dyads were recruited for this study between May 2022 and September 2022. Data were collected through semistructured interviews and analyzed using thematic analysis. In this study, four themes were identified: (1) poor relationship quality of the dyads, (2) dyadic incongruence in managing stroke, (3) a slow and tiring dyadic self-care process and (4) happy cooperation in coping with dyadic self-care. DISCUSSION AND CONCLUSION Healthcare professionals should give greater consideration to the contradictions and disparities that may arise between stroke survivors and caregivers during the self-care process. It is crucial for them to provide personalized and tailored support and interventions that can assist these individuals in achieving a more optimal balance in their dyadic self-care. PATIENT/PUBLIC CONTRIBUTION Patients were involved in the formulation of interview questions for this study. No members of the public were involved in this study.
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Affiliation(s)
- Wenna Wang
- Academy of Medical SciencesZhengzhou UniversityZhengzhouHenanChina
- School of Nursing and HealthZhengzhou UniversityZhengzhouHenanChina
| | - Gianluca Pucciarelli
- Department of Biomedicine and PreventionUniversity of Rome “Tor Vergata”RomeItaly
| | - Yongxia Mei
- School of Nursing and HealthZhengzhou UniversityZhengzhouHenanChina
| | - Zhenxiang Zhang
- School of Nursing and HealthZhengzhou UniversityZhengzhouHenanChina
| | - Ercole Vellone
- Department of Biomedicine and PreventionUniversity of Rome “Tor Vergata”RomeItaly
- Department of Nursing and ObstetricsWroclaw Medical UniversityWrocławPoland
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Ramaswamy S, Gilles N, Gruessner AC, Burton D, Fraser MA, Weingast S, Kunnakkat S, Afable A, Kaufman D, Singer J, Balucani C, Levine SR. User-Centered Mobile Applications for Stroke Survivors (MAPPS): A Mixed-Methods Study of Patient Preferences. Arch Phys Med Rehabil 2023; 104:1573-1579. [PMID: 37295706 DOI: 10.1016/j.apmr.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Investigate stroke survivors' (SS) preferences for a hypothetical mHealth app for post-stroke care and to study the influence of demographic variables on these preferences. DESIGN Mixed-methods, sequential, observational study. SETTING Focus groups (phase 1) were conducted to identify SS perceptions and knowledge of mHealth applications (apps). Using grounded theory approach, recurring themes were identified. A multiple-choice questionnaire of 5 desired app features was generated using these themes and mailed to SS (national survey, phase 2). SS' demographics and perceived usefulness (yes/no) for each feature were recorded. In-person usability testing (phase 3) was conducted to identify areas of improvement in user interfaces of existing apps. Summative telephone interviews (phase 4) were conducted for final impressions supplementary to national survey. PARTICIPANTS SS aged >18 years recruited from study hospital, national stroke association database, stroke support and advocacy groups. Non-English speakers and those unable to communicate were excluded. INTERVENTIONS None. MAIN OUTCOME MEASURES (1) Percentage of SS (phase 2) identifying proposed app features to be useful. (2) Influence of age, sex, race, education, and time since stroke on perceived usefulness. RESULTS Ninety-six SS participated in focus groups. High cost, complexity, and lack of technical support were identified as barriers to adoption of mHealth apps. In the national survey (n=1194), ability to track fitness and diet (84%) and communication (70%) were the most and least useful features, respectively. Perceived usefulness was higher among younger SS (P<.001 to .006) and SS of color (African American and Hispanic) (ORs 1.73-4.41). Simple design and accommodation for neurologic deficits were main recommendations from usability testing. CONCLUSIONS SS are willing to adopt mHealth apps that are free of cost and provide technical support. Apps for SS should perform multiple tasks and be of simple design. Greater interest for the app's features among SS of color may provide opportunities to address health inequities.
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Affiliation(s)
- Srinath Ramaswamy
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY.
| | - Nadege Gilles
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | | | - Dee Burton
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | | | - Sarah Weingast
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Saroj Kunnakkat
- Department of Neurology, Case Western Reserve University, Cleveland, OH
| | - Aimee Afable
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - David Kaufman
- Department of Medical Informatics, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Jonathan Singer
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX
| | | | - Steven R Levine
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY
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Dubach RA, Tripathi NS. Secondary Stroke Prevention Education: Occupational Therapy Practitioners’ Implementation and Perceptions. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2023. [DOI: 10.1080/02703181.2023.2165593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Rebecca A. Dubach
- Department of Occupational Therapy, College of Nursing and Health Professions, Valparaiso University, Valparaiso, Indiana, USA
| | - Neha S. Tripathi
- Department of Occupational Therapy, College of Nursing and Health Professions, Valparaiso University, Valparaiso, Indiana, USA
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Scott Reid P, Neville E, Cater F, Mullis R, Mant J, Duschinsky R. Accounts of preventative coping: an interview study of stroke survivors on general practice registers. BMJ Open 2022; 12:e058441. [PMID: 36691146 PMCID: PMC9445822 DOI: 10.1136/bmjopen-2021-058441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 06/20/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Preventative coping is an underexplored aspect of coping behaviour. Specifically, coping is a key concern in stroke survivor accounts, but this has yet to be investigated with reference to secondary prevention. DESIGN Secondary analysis of a qualitative data set comprising semistructured interviews of 22 stroke survivors recruited from five general practices in the East of England. The topic guide included exploration of advice and support given by their doctor on medication and lifestyle. The interviews were coded using thematic analysis. RESULTS The accounts emphasised individual responsibility. Two key themes were identified, which foregrounded the role of self-concept for coping: (a) striving to be 'good', (b) appeal to ideas of 'personality'. In the former, preventative behaviour was depicted in moralistic terms, with the doctor as an adjudicator. In the latter, participants attributed their coping behaviour to their personality, which might help or hinder these efforts. CONCLUSIONS We highlight that coping was characterised by survivors as something enacted by the individual self, and consider how constructions of self may impact preventative coping efforts.
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Affiliation(s)
| | - Emma Neville
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Frances Cater
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Ricky Mullis
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, University of Cambridge, Cambridge, UK
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8
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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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Turner GM, Aquino MRJV, Atkins L, Foy R, Mant J, Calvert M. Factors influencing follow-up care post-TIA and minor stroke: a qualitative study using the theoretical domains framework. BMC Health Serv Res 2022; 22:235. [PMID: 35189884 PMCID: PMC8859903 DOI: 10.1186/s12913-022-07607-0] [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] [Received: 10/11/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Follow-up care after transient ischaemic attack (TIA) and minor stroke has been found to be sub-optimal, with individuals often feeling abandoned. We aimed to explore factors influencing holistic follow-up care after TIA and minor stroke. Methods Qualitative semi-structured interviews with 24 healthcare providers (HCPs): 5 stroke doctors, 4 nurses, 9 allied health professionals and 6 general practitioners. Participants were recruited from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Interview transcripts were deductively coded using the Theoretical Domains Framework and themes were generated from coded data. Results There was no clear pathway for supporting people with TIA or minor stroke after rapid specialist review in hospital; consequently, these patients had limited access to HCPs from all settings (‘Environmental context and resources’). There was lack of understanding of potential needs post-TIA/minor stroke, in particular residual problems such as anxiety/fatigue (‘Knowledge’). Identification and management of needs was largely influenced by HCPs’ perceived role, professional training (‘Social professional role and identity’) and time constraints (‘Environmental context and resources’). Follow-up was often passive – with onerous on patients to seek support – and predominantly focused on acute medical management (‘Intentions’/‘Goal’). Conclusions Follow-up care post-TIA/minor stroke is currently sub-optimal. Through identifying factors which influence follow-up, we can inform guidelines and practical strategies to improve holistic healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07607-0.
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Affiliation(s)
- Grace M Turner
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK. .,Centre for Patient Reported Outcomes Research, University of Birmingham, B15 2TT, Birmingham, UK. .,NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, Birmingham, UK.
| | - Maria Raisa Jessica V Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Lou Atkins
- Centre for Behaviour Change, University College London, WC1E 6BT, London, UK
| | - Robbie Foy
- Leeds Institute for Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, B15 2TT, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, B15 2TT, Birmingham, UK.,NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, B15 2TT, Birmingham, UK
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Lehmann J, Riedl D, Sztankay M, Boehme C, Fischnaller J, Kiechl S, Holzner B, Knoflach M, Rumpold G. The Attitude towards Polypills Questionnaire (APPQ): a phase I-III development and validation study in patients with cerebrovascular disease. Eur J Neurol 2021; 28:4039-4050. [PMID: 34463018 PMCID: PMC9292587 DOI: 10.1111/ene.15088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The polypill approach has been proposed to reduce patients' pill burden, increase medication adherence and lower stroke incidence. However, little is known about patients' attitudes towards polypills for cerebrovascular medication. METHODS Based on the European Organization for Research and Treatment of Cancer Quality of Life Group questionnaire development guidelines, a questionnaire to measure patients' attitudes towards polypills for the secondary prevention of stroke (phase I-III) was developed. In phase I, issues were generated via literature review and interviews with patients and healthcare professionals. The issues were operationalized into items in phase II. In phase III the questionnaire was validated in a large single-centre sample, and test-retest and internal validity were evaluated. RESULTS In phase I, 34 relevant issues were identified through literature search and interviews. Pre-testing the questionnaire indicated high applicability and comprehensibility. The final Attitudes towards Polypills Questionnaire was tested in N = 260 patients and showed a two-factor structure. The factors were labelled 'concerns' and 'benefits'. The scales showed acceptable and good internal validity (concerns, Cronbach's α = 0.85; benefits, α = 0.93), but the scales' test-retest validity was ambiguous. On a 0 to 3 rating scale, concerns were rated lower than benefits (mean 1.07, SD 0.69 vs. mean 1.87, SD 0.89). CONCLUSIONS The Attitudes towards Polypills Questionnaire showed high comprehensibility and content validity to assess German language patients' attitudes towards a polypill medication. Our data and questionnaire may aid the implementation of polypill treatments in clinical practice and can be used in the design of future clinical trials on polypill therapy. Further validation of the questionnaire is advised.
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Affiliation(s)
- Jens Lehmann
- University Hospital of Psychiatry IIMedical University of InnsbruckInnsbruckAustria
| | - David Riedl
- University Clinic of Medical PsychologyMedical University of InnsbruckInnsbruckAustria
| | - Monika Sztankay
- University Hospital of Psychiatry IIMedical University of InnsbruckInnsbruckAustria
| | - Christian Boehme
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Stefan Kiechl
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
- VASCage—Research Centre on Vascular Ageing and StrokeInnsbruckAustria
| | - Bernhard Holzner
- University Hospital of Psychiatry IMedical University of InnsbruckInnsbruckAustria
- Evaluation Software Development GmbHInnsbruckAustria
| | - Michael Knoflach
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
- VASCage—Research Centre on Vascular Ageing and StrokeInnsbruckAustria
| | - Gerhard Rumpold
- University Clinic of Medical PsychologyMedical University of InnsbruckInnsbruckAustria
- Evaluation Software Development GmbHInnsbruckAustria
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Sui W, Wan LH. Association Between Patient Activation and Medication Adherence in Patients With Stroke: A Cross-Sectional Study. Front Neurol 2021; 12:722711. [PMID: 34659088 PMCID: PMC8516066 DOI: 10.3389/fneur.2021.722711] [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: 06/11/2021] [Accepted: 08/19/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Medication adherence is key to secondary prevention in patients with stroke. Poor medication adherence can lead to recurrence, disability, or even death in stroke survivors. Patient activation is associated with increased healthy behaviors and improved clinical outcomes in many chronic diseases. However, the association between patient activation and medication adherence in patients with stroke remains unclear. Objective: The study aimed to explore the influence of patient activation on the medication adherence of patients with stroke and to analyze the reasons for medication nonadherence. Materials and Methods: A cross-sectional design with convenience sampling was used in this study. A total of 119 patients with stroke were recruited from a tertiary hospital in Guangzhou. A social-demographic and clinical data form, a self-developed medication adherence questionnaire, and the 13-item Patient Activation Measure (PAM-13) were used. Univariate analysis and multiple linear regression analysis with dummy variables were conducted to investigate the associations between medication adherence and patient activation. Data were analyzed with IBM® SPSS® version 25.0. Results: The mean PAM-13 score in patients with stroke was 51.56 ± 12.58. A low level of patient activation was reported by up to 66.4% of the patients. The self-reported medication adherence questionnaire score was 5.59 ± 1.52. A low level of medication adherence was reported by up to 59.7% of the patients, while a moderate level was reported by 34.4%, and a high level was reported by only 5.9%. In the multiple stepwise regression analysis, patient activation was found to be an independent influencing factor of medication adherence in patients with stroke (p < 0.05). Conclusion: Medication adherence was poor in patients in Guangzhou, China, following an ischemic stroke. Patient activation as the independent influencing factor identified in this study will support healthcare givers to develop the tailored intervention to improve medication adherence among patients with stroke in China.
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Affiliation(s)
- Weijing Sui
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Hong Wan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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12
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Xu J, Zhao M, Vrosgou A, Yu NCW, Liu C, Zhang H, Ding C, Roth NW, Pan Y, Liu L, Wang Y, Wang Y, Bettger JP. Barriers to medication adherence in a rural-urban dual economy: a multi-stakeholder qualitative study. BMC Health Serv Res 2021; 21:799. [PMID: 34380492 PMCID: PMC8359298 DOI: 10.1186/s12913-021-06789-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/26/2021] [Indexed: 11/07/2022] Open
Abstract
Background One of the most cost-effective treatments for secondary prevention of stroke and other non-communicable diseases is a long-term medication regimen. However, the complexities of medication adherence extend far beyond individual behavior change, particularly in low- and middle-income countries. The purpose of this study was to examine stakeholder perspectives on barriers to medication adherence for stroke patients in Beijing, China, identifying opportunities to improve care and policy in resource-constrained settings. Methods We conducted a qualitative, phenomenological analysis of data obtained from 36 individuals. Participants were patients; caregivers; healthcare providers; and representatives from industry and government, purposively selected to synthesize multiple perspectives on medication management and adherence for stroke secondary prevention in Beijing, China. Data was analyzed by thematic analysis across iterative coding cycles. Results Four major themes characterized barriers on medication adherence, across stakeholders and geographies: limitations driven by individual patient knowledge / attitudes; lack of patient-provider interaction time; lack of coordination across the stratified health system; and lack of affordability driven by high overall costs and limited insurance policies. Conclusions These barriers to medication management and adherence suggest opportunities for policy reform and local practice changes, particularly for multi-tiered health systems. Findings from this study in Beijing, China could be explored for applicability in other low- and middle-income countries with urban centers serving large geographic regions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06789-3.
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Affiliation(s)
- Jacqueline Xu
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA.
| | - Mengxi Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Athina Vrosgou
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA.,Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK
| | - Natalie Chin Wen Yu
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA.,Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Chelsea Liu
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Han Zhang
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Chunxi Ding
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | | | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Janet Prvu Bettger
- Department of Orthopaedics, Duke University School of Medicine, Durham, NC, USA.,Duke Global Health Institute, Duke University, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
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13
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Ganesh A, Ospel JM, Marko M, van Zwam WH, Roos YBWEM, Majoie CBLM, Goyal M. From Three-Months to Five-Years: Sustaining Long-Term Benefits of Endovascular Therapy for Ischemic Stroke. Front Neurol 2021; 12:713738. [PMID: 34381418 PMCID: PMC8350336 DOI: 10.3389/fneur.2021.713738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: During the months and years post-stroke, treatment benefits from endovascular therapy (EVT) may be magnified by disability-related differences in morbidity/mortality or may be eroded by recurrent strokes and non-stroke-related disability/mortality. Understanding the extent to which EVT benefits may be sustained at 5 years, and the factors influencing this outcome, may help us better promote the sustenance of EVT benefits until 5 years post-stroke and beyond. Methods: In this review, undertaken 5 years after EVT became the standard of care, we searched PubMed and EMBASE to examine the current state of the literature on 5-year post-stroke outcomes, with particular attention to modifiable factors that influence outcomes between 3 months and 5 years post-EVT. Results: Prospective cohorts and follow-up data from EVT trials indicate that 3-month EVT benefits will likely translate into lower 5-year disability, mortality, institutionalization, and care costs and higher quality of life. However, these group-level data by no means guarantee maintenance of 3-month benefits for individual patients. We identify factors and associated “action items” for stroke teams/systems at three specific levels (medical care, individual psychosocioeconomic, and larger societal/environmental levels) that influence the long-term EVT outcome of a patient. Medical action items include optimizing stroke rehabilitation, clinical follow-up, secondary stroke prevention, infection prevention/control, and post-stroke depression care. Psychosocioeconomic aspects include addressing access to primary care, specialist clinics, and rehabilitation; affordability of healthy lifestyle choices and preventative therapies; and optimization of family/social support and return-to-work options. High-level societal efforts include improving accessibility of public/private spaces and transportation, empowering/engaging persons with disability in society, and investing in treatments/technologies to mitigate consequences of post-stroke disability. Conclusions: In the longtime horizon from 3 months to 5 years, several factors in the medical and societal spheres could negate EVT benefits. However, many factors can be leveraged to preserve or magnify treatment benefits, with opportunities to share responsibility with widening circles of care around the patient.
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Affiliation(s)
- Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | | | - Martha Marko
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | | | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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14
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Prevention of Non-Cardiogenic Ischemic Stroke: Towards Personalized Stroke Care. Stroke 2021. [DOI: 10.36255/exonpublications.stroke.personalizedcare.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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15
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Rai T, Morton K, Roman C, Doogue R, Rice C, Williams M, Schwartz C, Velardo C, Tarassenko L, Yardley L, McManus RJ, Hinton L. Optimizing a digital intervention for managing blood pressure in stroke patients using a diverse sample: Integrating the person-based approach and patient and public involvement. Health Expect 2021; 24:327-340. [PMID: 33316120 PMCID: PMC8077154 DOI: 10.1111/hex.13173] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Having a stroke or transient ischaemic attack increases the risk of a subsequent one, especially with high blood pressure (BP). Home-based BP management can be effective at maintaining optimal BP. OBJECTIVE To describe the optimization of a digital intervention for stroke patients and the value of participant diversity, using the person-based approach (PBA) and integral patient and public involvement (PPI). SETTING AND PARTICIPANTS Stroke patients recruited from primary care and community settings, and health-care professionals in primary care, in England and Ireland. DESIGN Three linked qualitative studies conducted iteratively to develop an intervention using the PBA, with integral PPI. INTERVENTION The BP: Together intervention, adapted from existing BP self-monitoring interventions, is delivered via mobile phone or web interface to support self-monitoring of BP at home. It alerts patients and their clinicians when a change in antihypertensive medication is needed. FINDINGS Feedback from a diverse range of participants identified potential barriers, which were addressed to improve the intervention accessibility, feasibility and persuasiveness. Easy-to-read materials were developed to improve usability for patients with aphasia and lower literacy. The importance of including family members who support patient care was also highlighted. Feedback messages regarding medication change were refined to ensure usefulness for patients and clinicians. DISCUSSION Input from PPI alongside qualitative research with a diverse study sample allowed the creation of a simple and equitable BP management intervention for stroke patients. PATIENT INVOLVEMENT Two PPI co-investigators contributed to design, conduct of study, data interpretation and manuscript preparation; community PPI sessions informed early planning. Study participants were stroke patients and family members.
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Affiliation(s)
- Tanvi Rai
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Kate Morton
- School of PsychologyUniversity of SouthamptonSouthamptonUK
| | | | - Roisin Doogue
- Graduate Entry Medical SchoolUniversity of LimerickLimerickIreland
| | - Cathy Rice
- Public and Patient Involvement (PPI) ContributorBristolUK
| | | | - Claire Schwartz
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | | | - Lucy Yardley
- School of PsychologyUniversity of SouthamptonSouthamptonUK
- Department of Experimental PsychologyInstitute of Biomedical EngineeringUniversity of BristolBristolUK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
- The Healthcare Improvement Studies InstituteUniversity of CambridgeCambridgeUK
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16
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Hopstock LA, Morseth B, Cook S, Eggen AE, Grimsgaard S, Lundblad MW, Løchen ML, Mathiesen E, Nilsen A, Njølstad I. Treatment target achievement after myocardial infarction and ischaemic stroke: cardiovascular risk factors, medication use, and lifestyle: the Tromsø Study 2015-16. Eur J Prev Cardiol 2021; 29:362-370. [PMID: 33778888 DOI: 10.1093/eurjpc/zwab050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/03/2021] [Accepted: 03/12/2021] [Indexed: 12/29/2022]
Abstract
AIMS To investigate European guideline treatment target achievement in cardiovascular risk factors, medication use, and lifestyle, after myocardial infarction (MI) or ischaemic stroke, in women and men living in Norway. METHODS AND RESULTS In the population-based Tromsø Study 2015-16 (attendance 65%), 904 participants had previous validated MI and/or stroke. Cross-sectionally, we investigated target achievement for blood pressure (<140/90 mmHg, <130/80 mmHg if diabetes), LDL cholesterol (<1.8 mmol/L), HbA1c (<7.0% if diabetes), overweight (body mass index (BMI) <25 kg/m2, waist circumference women <80 cm, men <94 cm), smoking (non-smoking), physical activity (self-reported >sedentary, accelerometer-measured moderate-to-vigorous ≥150 min/week), diet (intake of fruits ≥200 g/day, vegetables ≥200 g/day, fish ≥200 g/week, saturated fat <10E%, fibre ≥30 g/day, alcohol women ≤10 g/day, men ≤20 g/day), and medication use (antihypertensives, lipid-lowering drugs, antithrombotics, and antidiabetics), using regression models. Proportion of target achievement was for blood pressure 55.2%, LDL cholesterol 9.0%, HbA1c 42.5%, BMI 21.1%, waist circumference 15.7%, non-smoking 86.7%, self-reported physical activity 79%, objectively measured physical activity 11.8%, intake of fruit 64.4%, vegetables 40.7%, fish 96.7%, saturated fat 24.3%, fibre 29.9%, and alcohol 78.5%, use of antidiabetics 83.6%, lipid-lowering drugs 81.0%, antihypertensives 75.9%, and antithrombotics 74.6%. Only 0.7% achieved all cardiovascular risk factor targets combined. Largely, there was little difference between the sexes, and in characteristics, medication use, and lifestyle among target achievers compared to non-achievers. CONCLUSION Secondary prevention of cardiovascular disease was suboptimal. A negligible proportion achieved the treatment target for all risk factors. Improvement in follow-up care and treatment after MI and stroke is needed.
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Affiliation(s)
- Laila A Hopstock
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway.,Pandemic Unit, Tromsø Municipality, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sarah Cook
- Faculty of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Elise Eggen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway
| | - Marie W Lundblad
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway
| | - Ellisiv Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Amalie Nilsen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway.,Department of Medicine, Nordland Hospital, Bodø, Norway
| | - Inger Njølstad
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway
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17
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Bai F, Chen J, Pandey D, Durazo-Arvizu R, Talavera GA, Allison MA, Perreira KM, Schneiderman N, Sutherland MW, Cai J, Daviglus ML, Testai FD. Stroke Risk Factor Status and Use of Stroke Prevention Medications Among Hispanic/Latino Adults in HCHS/SOL. Stroke 2021; 52:1339-1346. [PMID: 33657859 DOI: 10.1161/strokeaha.120.031216] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the prevalence, awareness, and control of vascular risk factors (VRFs) and the use of antithrombotic and statin agents in HCHS (Hispanic Community Health Study)/SOL (Study of Latinos) participants with self-reported history of stroke or transient ischemic attack. METHODS Sociodemographic characteristics, medications, and prevalence of different VRFs were recorded. VRF diagnoses and goals were based on the recommendations of professional organizations. Factors associated with optimal VRF control and use of antithrombotic and statin agents were investigated using multivariate logistic regression. RESULTS The analysis included 404 participants (39% men). The prevalences of hypertension, dyslipidemia, and diabetes were 59%, 65%, and 39%, respectively. Among those who met the diagnostic criteria for these diagnoses, the frequencies of awareness were 90%, 75%, and 83%, respectively. In participants who were aware of their VRFs, the prevalences of controlled hypertension, dyslipidemia, and diabetes were 46%, 32%, and 54%. Approximately 46% of the participants were on antithrombotics, 39% on statins, and 26% on both. Only 38% of those with atrial fibrillation received anticoagulation. In multivariate analyses adjusted for baseline sociodemographic characteristics, older age was associated with uncontrolled hypertension and diabetes. Residing in the United States for ≥10 years and born in the United States were associated with uncontrolled diabetes, female sex with uncontrolled dyslipidemia, and lack of health insurance with decreased use of statins and hyperlipidemia. CONCLUSIONS Hispanic/Latino adults in the United States have high prevalence and awareness of VRFs but low adherence to secondary stroke prevention strategies. Older adults, women, and uninsured people are vulnerable groups that may benefit from targeted interventions. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02060344.
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Affiliation(s)
- Fang Bai
- Department of Neurology and Rehabilitation (F.B., D.P., F.D.T.), University of Illinois at Chicago
| | - Jingsong Chen
- Institute for Minority Health Research (J.C., R.D.-A., M.L.D.), University of Illinois at Chicago
| | - Dilip Pandey
- Department of Neurology and Rehabilitation (F.B., D.P., F.D.T.), University of Illinois at Chicago
| | - Ramon Durazo-Arvizu
- Institute for Minority Health Research (J.C., R.D.-A., M.L.D.), University of Illinois at Chicago
| | - Gregory A Talavera
- Graduate School of Public Health, San Diego State University, CA (G.A.T.)
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla (M.A.A.)
| | - Krista M Perreira
- Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill (K.M.P., J.C.)
| | - Neil Schneiderman
- Department of Psychology, Behavioral Medicine Research Center, University of Miami, FL (N.S.)
| | - Melanie W Sutherland
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia (M.W.S.)
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill (K.M.P., J.C.)
| | - Martha L Daviglus
- Institute for Minority Health Research (J.C., R.D.-A., M.L.D.), University of Illinois at Chicago
| | - Fernando D Testai
- Department of Neurology and Rehabilitation (F.B., D.P., F.D.T.), University of Illinois at Chicago
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18
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Kose E, Endo H, Hori H, Hosono S, Kawamura C, Kodama Y, Yamazaki T, Yasuno N. Pharmacist medication instructions are associated with continued medication self-management in older adults: a retrospective observational study. J Pharm Health Care Sci 2021; 7:11. [PMID: 33653415 PMCID: PMC7927227 DOI: 10.1186/s40780-021-00194-y] [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] [Received: 10/20/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Various factors are related to self-management of medication. However, few reports comprehensively examine the factors related to patients, medication levels, and other factors related to the recuperative environment, such as family support. The aim of this study was to investigate factors affecting the continuation of medication self-management among hospitalized older adults receiving convalescent rehabilitation. Methods We conducted a retrospective observational study with 274 consecutive patients newly admitted to the convalescent rehabilitation wards at a single hospital in Japan between January 2017 and May 2018. Participants who were assessed for their ability to take their medication using the Japanese Regimen Adherence Capacity Tests, were deemed to be self-manageable, and were able to successfully continue to self-manage their medication from admission to discharge were categorized as the “continuation group,” and those who were not able to continue were categorized as the “non-continuation group.” We analyzed the groups’ demographic data, laboratory data, and Functional Independence Measure. The primary outcome was the continuation of medication self-management from admission to discharge. Results After enrollment, 134 patients (median age 82 years; 62.7% women) were included in the final analysis. Some 60.4% of eligible patients were able to maintain medication self-management during their hospitalization. The multiple logistic regression analysis for the continuation of medication self-management during hospitalization after adjusting for confounding factors revealed that pharmacist medication instructions were independently and positively correlated with successful continuation of medication self-management (odds ratio: 1.378; 95% confidence interval 1.085–1.831; p = 0.0076). Conclusion Successful continuation of medication self-management is associated with pharmacist medication instructions among hospitalized older adults undergoing rehabilitation. Trail registration The Ethics Committee’s registration number is “TGE01216–066”.
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Affiliation(s)
- Eiji Kose
- Department of Pharmacy, Teikyo University School of Medicine University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan.
| | - Hidetatsu Endo
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Hiroko Hori
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Shingo Hosono
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Chiaki Kawamura
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Yuta Kodama
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Takashi Yamazaki
- Department of Pharmacy, Ogaki Tokushukai Hospital, 6-85-1 Hayashi-chou, Ogaki, Gifu, 503-0015, Japan
| | - Nobuhiro Yasuno
- Department of Pharmacy, Teikyo University School of Medicine University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan.,Laboratory of Hospital Pharmacy, School of Pharmacy, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
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19
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Laar A, Amoah Ampah E, Fernandez Y, Senyo Amevinya G, Nortey P, Benyah F, Akamah J, Ambenne M, Lamptey P, Free C, Legido-Quigley H, Perel P. 'What the herbal medicine can do for me in a week, the orthodox does in a year': Perceived efficacy of local alternative therapies influences medication adherence in patients with atherosclerotic cardiovascular disease. Health Expect 2021; 24:444-455. [PMID: 33528881 PMCID: PMC8077140 DOI: 10.1111/hex.13185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background There is strong evidence that anti‐platelet therapy, ACE inhibitors, beta‐blockers and statins are cost‐effective in reducing subsequent cardiovascular disease (CVD) events in patients with atherosclerotic cardiovascular disease (ACVD). In some settings, only a low proportion of people have access to these medications, and even lower adhere to them. The current study explored and presents data on the causes of poor adherence to orthodox medication and motivations for alternative therapies in patients with established atherosclerotic cardiovascular disease (ACVD). Methods The study was conducted among city‐dwelling adults with ACVD in Accra – Ghana's capital city. Eighteen interviews were conducted with patients with established ACVD. A follow‐up focus group discussion was conducted with some of them. The protocol was approved by two ethics review committees based in Ghana and in the United Kingdom. All participants were interviewed after informed consent. Analysis was done with the Nvivo qualitative data analysis software. Results We identified motivations for use of alternatives to orthodox therapies. These cover the five dimensions of adherence: social and economic, health‐care system, condition‐related, therapy‐related, and patient‐related dimensions. Perceived inability of an orthodox medication to provide immediate benefit is an important motivator for use of alternative forms of medication. Conclusions A multiplicity of factors precipitate non‐adherence to orthodox therapies. Perceived efficacy and easy access to local alternative therapies such as herbal and faith‐based therapies are important motivators.
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Affiliation(s)
- Amos Laar
- Department of Population, Family, & Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana.,House of Mentoring and Research Resources (HM2R). Box LG 1099, University Post Office, Legon, Accra, Ghana
| | - Ernest Amoah Ampah
- House of Mentoring and Research Resources (HM2R). Box LG 1099, University Post Office, Legon, Accra, Ghana
| | - Yolanda Fernandez
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine. Keppel St, London, UK
| | - Gideon Senyo Amevinya
- Department of Population, Family, & Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana.,House of Mentoring and Research Resources (HM2R). Box LG 1099, University Post Office, Legon, Accra, Ghana
| | - Priscillia Nortey
- Department of Epidemiology and Disease Control, School of Public Health Box LG 13, University of Ghana, Legon, Accra, Ghana
| | | | - Joseph Akamah
- Department of Medicine and Therapeutics, Divisions of Cardiology and Neurology, School of Medicine and Dentistry, University of Ghana, Korle-Bu, Ghana
| | - Marcella Ambenne
- House of Mentoring and Research Resources (HM2R). Box LG 1099, University Post Office, Legon, Accra, Ghana
| | - Peter Lamptey
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine. Keppel St, London, UK
| | - Caroline Free
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine Keppel St, London, UK
| | - Helena Legido-Quigley
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine. Keppel St, London, UK
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine. Keppel St, London, UK
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20
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Mathew T, John S, Souza D, Nadig R, Badachi S, K Sarma GR. Recurrent Ischemic Strokes: “Discontinuation of Antiplatelet Drugs Appears to be an Important Preventable Cause”. Neurol India 2021; 69:1743-1746. [DOI: 10.4103/0028-3886.333533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Widjaja KK, Chulavatnatol S, Suansanae T, Wibowo YI, Sani AF, Islamiyah WR, Nathisuwan S. Knowledge of stroke and medication adherence among patients with recurrent stroke or transient ischemic attack in Indonesia: a multi-center, cross-sectional study. Int J Clin Pharm 2020; 43:666-672. [PMID: 33124676 DOI: 10.1007/s11096-020-01178-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BackgroundThere is a limited data in Indonesia regarding the stroke knowledge and medication adherence among stroke survivors.ObjectiveTo assess the level of stroke knowledge and medication adherence along with their relationship among stroke survivors.SettingTwo tertiary-care hospitals in Surabaya, East Java, Indonesia.MethodsA prospective, cross-sectional study was conducted among 215 stroke survivors. Stroke Knowledge Test and the Morisky Green Levine Adherence Scale questionnaires were used to evaluate stroke knowledge and medication adherence, respectively. Binary logistic regression was performed to assess the rela tionship between stroke knowledge and medication adherence. Main outcome measuresRelationship between stroke knowledge and medication adherence.ResultsA total of 215 patients with mean age of 56.34 ± 8.69 years were recruited into this study. Mean Stroke Knowledge Test score was 7.89 ± 3.38 with 76.7% had low level of stroke knowledge. Mean Morisky Green Levine Adherence Scale was 3.05 ± 1.11 with 52.1% had low to medium medication adherence. Education and duration of stroke correlated with stroke knowledge level (Spearman's correlation coefficient: 0.307, p = 0.001 and 0.128, p = 0.041, respectively). Age and disability correlated with medication adherence (Spearman's correlation coefficient: 0.169; p = 0.013 and 0.171; p = 0.012), respectively. After adjustment for covariates, stroke knowledge level was independently associated with medication adherence (adjusted OR: 4.37, 95% CI 2.00-9.53; p < 0.001).ConclusionStroke knowledge was low among Indonesian stroke survivors and independently related to medication adherence. Attempts should be made to increase stroke knowledge which may improve medication adherence among stroke survivors.
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Affiliation(s)
- Karina Kumaladewi Widjaja
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suvatna Chulavatnatol
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Thanarat Suansanae
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Yosi Irawati Wibowo
- Centre for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
| | - Achmad Firdaus Sani
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand.
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22
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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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23
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Bufalino VJ, Bleser WK, Singletary EA, Granger BB, O'Brien EC, Elkind MSV, Hamilton Lopez M, Saunders RS, McClellan MB, Brown N. Frontiers of Upstream Stroke Prevention and Reduced Stroke Inequity Through Predicting, Preventing, and Managing Hypertension and Atrial Fibrillation: A Call to Action From the Value in Healthcare Initiative's Predict & Prevent Learning Collaborative. Circ Cardiovasc Qual Outcomes 2020; 13:e006780. [PMID: 32683982 DOI: 10.1161/circoutcomes.120.006780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is one of the leading causes of morbidity and mortality in the United States. While age-adjusted stroke mortality was falling, it has leveled off in recent years due in part to advances in medical technology, health care options, and population health interventions. In addition to adverse trends in stroke-related morbidity and mortality across the broader population, there are sociodemographic inequities in stroke risk. These challenges can be addressed by focusing on predicting and preventing modifiable upstream risk factors associated with stroke, but there is a need to develop a practical framework that health care organizations can use to accomplish this task across diverse settings. Accordingly, this article describes the efforts and vision of the multi-stakeholder Predict & Prevent Learning Collaborative of the Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. This article presents a framework of a potential upstream stroke prevention program with evidence-based implementation strategies for predicting, preventing, and managing stroke risk factors. It is meant to complement existing primary stroke prevention guidelines by identifying frontier strategies that can address gaps in knowledge or implementation. After considering a variety of upstream medical or behavioral risk factors, the group identified 2 risk factors with substantial direct links to stroke for focusing the framework: hypertension and atrial fibrillation. This article also highlights barriers to implementing program components into clinical practice and presents implementation strategies to overcome those barriers. A particular focus was identifying those strategies that could be implemented across many settings, especially lower-resource practices and community-based enterprises representing broad social, economic, and geographic diversity. The practical framework is designed to provide clinicians and health systems with effective upstream stroke prevention strategies that encourage scalability while allowing customization for their local context.
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Affiliation(s)
| | - William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Elizabeth A Singletary
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Bradi B Granger
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Emily C O'Brien
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Marianne Hamilton Lopez
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Robert S Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Mark B McClellan
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Nancy Brown
- American Heart Association, Dallas, TX (N.B.)
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24
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Seaman KL, Sanfilippo FM, Bulsara MK, Brett T, Kemp-Casey A, Roughead EE, Bulsara C, Preen DB. Frequent general practitioner visits are protective against statin discontinuation after a Pharmaceutical Benefits Scheme copayment increase. AUST HEALTH REV 2020; 44:377-384. [PMID: 32389176 DOI: 10.1071/ah19069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022]
Abstract
Objective This study assessed the effect of the frequency of general practitioner (GP) visitation in the 12 months before a 21% consumer copayment increase in the Pharmaceutical Benefits Scheme (PBS; January 2005) on the reduction or discontinuation of statin dispensing for tertiary prevention. Methods The study used routinely collected, whole-population linked PBS, Medicare, mortality and hospital data from Western Australia. From 2004 to 2005, individuals were classified as having discontinued, reduced or continued their use of statins in the first six months of 2005 following the 21% consumer copayment increase on 1 January 2005. The frequency of GP visits was calculated in 2004 from Medicare data. Multivariate logistic regression models were used to determine the association between GP visits and statin use following the copayment increase. Results In December 2004, there were 22495 stable statin users for tertiary prevention of prior coronary heart disease, prior stroke or prior coronary artery revascularisation procedure. Following the copayment increase, patients either discontinued (3%), reduced (12%) or continued (85%) their statins. Individuals who visited a GP three or more times in 2004 were 47% less likely to discontinue their statins in 2005 than people attending only once. Subgroup analysis showed the effect was apparent in men, and long-term or new statin users. The frequency of GP visits did not affect the proportion of patients reducing their statin therapy. Conclusions Patients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs. What is known about the topic? Following the 21% increase in medication copayment in 2005, individuals discontinued or reduced their statin usage, including for tertiary prevention. What does this paper add? Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase. What are the implications for practitioners? This paper identifies the important role that GPs have in maintaining the continued use of important medications following rises in medicines costs.
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Affiliation(s)
- Karla L Seaman
- School of Health Sciences, University of Notre Dame, Fremantle, 19 Mouat Street, P.O. Box 1225, WA 6959, Australia; and School of Nursing and Midwifery, Edith Cowan University, Building 21, 270 Joondalup Drive, Joondalup, WA 6027, Australia; and Corresponding author.
| | - Frank M Sanfilippo
- Cardiovascular Research Group, School of Population and Global Health, University of Western Australia, M431, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, 19 Mouat Street, P.O. Box 1225, WA 6959, Australia. ;
| | - Tom Brett
- School of Medicine, University of Notre Dame, Fremantle, 19 Mouat Street, P.O. Box 1225, WA 6959, Australia.
| | - Anna Kemp-Casey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. ; ; and Center of Health Services Research, School of Population and Global Health, M431, 35 Stirling Highway, University of Western Australia, Crawley, WA 6009, Australia.
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. ;
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, 19 Mouat Street, P.O. Box 1225, WA 6959, Australia. ;
| | - David B Preen
- Center of Health Services Research, School of Population and Global Health, M431, 35 Stirling Highway, University of Western Australia, Crawley, WA 6009, Australia.
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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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26
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Kim GG, Chae DH, Park MS, Yoo SH. Factors Influencing 1-Year Medication Adherence of Korean Ischemic Stroke Survivors. Int J Behav Med 2020; 27:225-234. [PMID: 32026290 DOI: 10.1007/s12529-020-09854-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Medication adherence is important for secondary stroke prevention. However, suboptimal adherence to medication among patients after stroke or transient ischemic attack is reportedly 30.9%. We assessed medication adherence of Korean stroke survivors within 1 year of acute ischemic stroke and identified factors that influence adherence. METHODS We consecutively enrolled ischemic stroke survivors who visited the Department of Neurology of a university hospital from March 9 to June 15, 2016. Data were collected by face-to-face interviews using a structured questionnaire which assessed general characteristics, clinical characteristics, medication beliefs, social support, and depression. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale. Multiple logistic regression was used to identify factors independently associated with medication adherence. RESULTS Of the total 250 participants, 183 (73%) were in the optimal adherence group. Age (p = 0.035), smoking (p = 0.020), number of prescribed medicines (p = 0.037), frequency of daily doses (p = 0.040), and beliefs about medication (p < 0.001) were associated with medication adherence. Optimal medication adherence was associated with being a non-smoker (OR, 3.19; 95% CI, 1.29-7.87; p = 0.012), more prescribed medicines (OR, 1.27; 95% CI, 1.05-1.54; p = 0.014), less frequency of daily doses (OR, 0.37; 95% CI, 0.18-0.79; p = 0.010), and stronger beliefs about medication (OR, 1.09; 95% CI, 1.03-1.15; p = 0.004). CONCLUSION To improve medication adherence of stroke survivors, post-stroke care should focus on bolstering patients' belief in the necessity of medication and encouraging lifestyle modifications, such as quitting smoking, as well as prescribing medicine with simple regimens.
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Affiliation(s)
- Gye-Gyoung Kim
- College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Duck-Hee Chae
- College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Medical school, Chonnam National University, Gwangju, Republic of Korea
| | - Sung-Hee Yoo
- College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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27
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Affiliation(s)
- Katie I. Gallacher
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Bhautesh D. Jani
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Peter Hanlon
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Barbara I. Nicholl
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Frances S. Mair
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
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28
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Durand H, Casey M, Glynn LG, Hayes P, Murphy AW, Molloy GJ. A qualitative comparison of high and low adherers with apparent treatment-resistant hypertension. PSYCHOL HEALTH MED 2019; 25:64-77. [PMID: 31109176 DOI: 10.1080/13548506.2019.1619788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Poor adherence is a leading cause of apparent resistance to antihypertensive treatment. Recent empirical research has investigated predictors of adherence for primary care patients who are apparently resistant to treatment; however, questions remain regarding the variability in adherence behaviour among this group. This study aimed to investigate factors that may elucidate medication adherence among patients with apparent treatment-resistant hypertension (aTRH) using qualitative methods. Fourteen semi-structured interviews were conducted with patients undergoing treatment for aTRH in primary care in the West of Ireland. Patients who self-reported both high and low adherence in a previous quantitative study were purposively sampled. Data were analysed using thematic analysis. A public and patient involvement research group were active partners in developing the study protocol and interview topic guide. Three major themes were identified: beliefs about treatment, habits and routine, and health and health systems. High adherers reported favourable beliefs about antihypertensive treatment that had been validated by experience with taking the treatment over time, described strong medication-taking habits and stable routines, and positive relations with their GP. Low adherers expressed less coherence in their beliefs and used less effective strategies to support their medication-taking in daily life. The current findings are consistent with qualitative studies of adherence in other chronic conditions. Results reflect the difficulty for healthcare practitioners in identifying adherent versus non-adherent patients via conversation, and highlight the importance of accurate adherence assessment. Inception studies may provide an opportunity to better understand adherence behaviour across the illness trajectory.
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Affiliation(s)
- Hannah Durand
- Medication Adherence across the Lifespan (MEDAL) Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Monica Casey
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Liam G Glynn
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Peter Hayes
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.,Health Research Board Primary Care Clinical Trials Network Ireland, Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Gerard J Molloy
- Medication Adherence across the Lifespan (MEDAL) Group, School of Psychology, National University of Ireland, Galway, Ireland
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29
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Crayton E, Fahey M, Ashworth M, Besser SJ, Weinman J, Wright AJ. Psychological Determinants of Medication Adherence in Stroke Survivors: a Systematic Review of Observational Studies. Ann Behav Med 2018; 51:833-845. [PMID: 28421453 PMCID: PMC5636868 DOI: 10.1007/s12160-017-9906-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Medications targeting stroke risk factors have shown good efficacy, yet adherence is suboptimal. To improve adherence, its determinants must be understood. To date, no systematic review has mapped identified determinants into the Theoretical Domains Framework (TDF) in order to establish a more complete understanding of medication adherence. PURPOSE The aim of this study was to identify psychological determinants that most influence stroke survivors' medication adherence. METHODS In line with the prospectively registered protocol (PROSPERO CRD42015016222), five electronic databases were searched (1953-2015). Hand searches of included full text references were undertaken. Two reviewers conducted screening, data extraction and quality assessment. Determinants were mapped into the TDF. RESULTS Of 32,825 articles, 12 fulfilled selection criteria (N = 43,984 stroke survivors). Tested determinants mapped into 8/14 TDF domains. Studies were too heterogeneous for meta-analysis. Three TDF domains appeared most influential. Negative emotions ('Emotions' domain) such as anxiety and concerns about medications ('Beliefs about Consequences' domain) were associated with reduced adherence. Increased adherence was associated with better knowledge of medications ('Knowledge' domain) and stronger beliefs about medication necessity ('Beliefs about Consequences' domain). Study quality varied, often lacking information on sample size calculations. CONCLUSIONS This review provides foundations for evidence-based intervention design by establishing psychological determinants most influential in stroke survivors' medication adherence. Six TDF domains do not appear to have been tested, possibly representing gaps in research design. Future research should standardise and clearly report determinant and medication adherence measurement to facilitate meta-analysis. The range of determinants explored should be broadened to enable more complete understanding of stroke survivors' medication adherence.
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Affiliation(s)
- Elise Crayton
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Marion Fahey
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Sarah Jane Besser
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - John Weinman
- King's College London, Institute of Pharmaceutical Sciences, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
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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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Mendyk AM, Duhamel A, Bejot Y, Leys D, Derex L, Dereeper O, Detante O, Garcia PY, Godefroy O, Montoro FM, Neau JP, Richard S, Rosolacci T, Sibon I, Sablot D, Timsit S, Zuber M, Cordonnier C, Bordet R. Controlled Education of patients after Stroke (CEOPS)- nurse-led multimodal and long-term interventional program involving a patient's caregiver to optimize secondary prevention of stroke: study protocol for a randomized controlled trial. Trials 2018; 19:137. [PMID: 29471839 PMCID: PMC5824577 DOI: 10.1186/s13063-018-2483-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Setting up a follow-up secondary prevention program after stroke is difficult due to motor and cognitive impairment, but necessary to prevent recurrence and improve patients' quality of life. To involve a referent nurse and a caregiver from the patient's social circle in nurse-led multimodal and long-term management of risk factors after stroke could be an advantage due to their easier access to the patient and family. The aim of this study is to compare the benefit of optimized follow up by nursing personnel from the vascular neurology department including therapeutic follow up, and an interventional program directed to the patient and a caregiving member of their social circle, as compared with typical follow up in order to develop a specific follow-up program of secondary prevention of stroke. METHODS/DESIGN The design is a randomized, controlled, clinical trial conducted in the French Stroke Unit of the Strokavenir network. In total, 410 patients will be recruited and randomized in optimized follow up or usual follow up for 2 years. In both group, patients will be seen by a neurologist at 6, 12 and 24 months. The optimized follow up will include follow up by a nurse from the vascular neurology department, including therapeutic follow up, and a training program on secondary prevention directed to the patient and a caregiving member of their social circle. After discharge, a monthly telephone interview, in the first year and every 3 months in the second year, will be performed by the nurse. At 6, 12 and 24 month, the nurse will give the patient and caregiver another training session. Usual follow up is only done by the patient's general practitioner, after classical information on secondary prevention of risk factors during hospitalization. The primary outcome measure is blood pressure measured after the first year of follow up. Blood pressure will be measured by nursing personnel who do not know the group into which the patient has been randomized. Secondary endpoints are associated mortality, morbidity, recurrence, drug side-effects and medico-economic analysis. DISCUSSION The result of this trial is expected to provide the benefit of a nurse-led optimized multimodal and long-term interventional program for management of risk factors after stroke, personalizing the role of the nurse and including the patient's caregiver. TRIAL REGISTRATION ClinicalTrials.gov, NCT 02132364. Registered on 7 May 2014. EUDRACT, A 00473-40.
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Affiliation(s)
- Anne-Marie Mendyk
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France
| | - Alain Duhamel
- University Lille, CHU, EA2694, F-59000, Lille, France
| | - Yannick Bejot
- University Hospital and Medical School of Dijon, University of Burgundy, Digon, France
| | - Didier Leys
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France
| | - Laurent Derex
- Department of Stroke Medicine, Université Lyon 1, Lyon, France
| | - Olivier Dereeper
- Stroke Unit, Neurology Department, Calais Hospital, Calais, France
| | - Olivier Detante
- Université Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France
| | - Pierre-Yves Garcia
- Stroke Unit, Neurology Department, Compiègne Hospital, Compiègne, France
| | - Olivier Godefroy
- Department of Neurology and Functional Neuroscience Laboratory EA 4559, Amiens University Medical Center, Amiens, France
| | | | - Jean-Philippe Neau
- Department of Neurology, CHU of Poitiers, University of Poitiers, Poitiers, France
| | - Sébastien Richard
- Stroke unit, Department of Neurology, CHU of Nancy, Lorraine University, Nancy, France
| | - Thierry Rosolacci
- Stroke Unit, Neurology Department, Maubeuge Hospital, Maubeuge, France
| | - Igor Sibon
- Department of Neurology, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Denis Sablot
- Stroke Unit, Neurology Department, Perpignan Hospital, Perpignan, France
| | - Serge Timsit
- CHRU Brest, Department of Neurology and Stroke Unit, Université de Bretagne Occidentale, Brest, France
| | - Mathieu Zuber
- Department of Neurology, Saint-Joseph Hospital Center, AP - HP, Université Paris-Descartes, INSERM UMR S 919, Paris, France
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France
| | - Régis Bordet
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France.
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Koh JJK, Cheng RX, Yap Y, Haldane V, Tan YG, Teo KWQ, Srivastava A, Ong PS, Perel P, Legido-Quigley H. Access and adherence to medications for the primary and secondary prevention of atherosclerotic cardiovascular disease in Singapore: a qualitative study. Patient Prefer Adherence 2018; 12:2481-2498. [PMID: 30538432 PMCID: PMC6255116 DOI: 10.2147/ppa.s176256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is a growing public health threat globally, and many individuals remain undiagnosed, untreated, and their condition remains uncontrolled. The key to effective ASCVD management is adherence to pharmacotherapy, and non-adherence has been associated with an increased risk of cardiovascular events and complications such as stroke, further impacting a patient's ability to be adherent. Our qualitative study aimed to explore factors influencing medication adherence in the primary and secondary prevention of ASCVD in Singapore. We propose a synthesized framework, which expands on current understandings of the factors of medication adherence, as a frame of analysis in this study. METHODS We conducted in-depth, semi-structured interviews with 20 patients over the age of 40 with ASCVD and/or its risk factors in Singapore. QSR Nvivo 11 was used to conduct thematic analysis using an inductive approach. RESULTS Using a synthesized framework, we reported that complex medication regimens, the lack of support received during regimen changes, and the perceived seriousness of a condition could impact a patient's medication adherence. Key findings suggest that the relationship between health care professionals and patients impacted patient acceptability of the medication regimen and consequently medication adherence. Different patient beliefs regarding diagnosis, medication, and adherence had some bearing on the ability to perceive the need to adhere to their medication. Patients also reported that they could afford medication, sometimes with the help of family members. Patients also largely reported not needing help managing their medication, considering it an individual responsibility. CONCLUSION We identified key factors which future interventions looking to improve medication adherence ought to consider. These include changing patient perceptions of health systems, diagnosis, medication, and adherence; patient-centeredness in developing interventions that facilitate adherence through building self-efficacy and stronger support networks via patient empowerment and engagement; decreasing patient co-payments on medication; and cultivating a trusting patient-provider relationship.
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Affiliation(s)
- Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
| | - Rui Xiang Cheng
- Department of Pharmacy, National University of Singapore, Singapore
| | - Yicheng Yap
- Department of Pharmacy, National University of Singapore, Singapore
| | - Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
| | - Yao Guo Tan
- Department of Pharmacy, National University of Singapore, Singapore
| | | | - Aastha Srivastava
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
| | - Pei Shi Ong
- Department of Pharmacy, National University of Singapore, Singapore
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, UK,
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
- London School of Hygiene and Tropical Medicine, London, UK,
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Krivoy A, Stubbs B, Balicer RD, Weizman S, Feldman B, Hoshen M, Zalsman G, Hochman E, Shoval G. Low adherence to antidepressants is associated with increased mortality following stroke: A large nationally representative cohort study. Eur Neuropsychopharmacol 2017; 27:970-976. [PMID: 28886897 DOI: 10.1016/j.euroneuro.2017.08.428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/20/2017] [Accepted: 08/20/2017] [Indexed: 01/10/2023]
Abstract
Post stroke depression is common and pervasive. In the general population, there has been some controversy that antidepressant (AD) medication is associated with premature mortality. Data is still lacking regarding the association between adherence to antidepressants (AD) and all-cause mortality. In this retrospective analysis of a population-based cohort of patients, 32,361 post-stroke patients who purchased at least one AD were followed for all-cause mortality over 4-years. Adherence to AD was measured as a ratio between dispensed and prescribed durations and was modeled as: non-adherence (<20%, n=8619), poor (20-50%, n=5108), moderate (50-80%, n=5656), and good (>80%, n=12,978) adherence. Multivariable survival analyses, adjusted for demographic and clinical variables including physical comorbidities known to influence mortality, were conducted. Unadjusted mortality rates were 16.5%, 20.2%, 22.2% and 23.7% in those classified as non-adherent, poor, moderate and good adherence respectively (χ2=174.6, p<0.0001). In the adjusted model, the non-adherent and poor adherence groups had significantly increased mortality Hazard Ratios (HR) of 1.25 (95% CI: 1.17-1.33) and 1.17 (95% CI: 1.09-1.26) respectively compared to the good adherence group. This nationally representative data suggests that poor adherence to AD is associated with increased all-cause mortality among people who had a stroke. Given our findings and the high prevalence of anxiety and depression along with AD effectiveness, efforts to promote AD adherence in this population may be warranted in clinical practice.
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Affiliation(s)
- Amir Krivoy
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom
| | - Ran D Balicer
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Shira Weizman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Becca Feldman
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | - Gil Zalsman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA
| | - Eldar Hochman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Shoval
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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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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Look KA, Stone JA. Medication management activities performed by informal caregivers of older adults. Res Social Adm Pharm 2017; 14:418-426. [PMID: 28528023 DOI: 10.1016/j.sapharm.2017.05.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/13/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Medication management is commonly performed by informal caregivers, yet they are often unprepared and ill-equipped to manage complex medication regimens for their older adult care recipients. In order to develop interventions that will enhance the caregiver's ability to safely and confidently manage medications, it is critical to first understand caregiver challenges and unmet needs related to medication management. OBJECTIVES To explore how informal caregivers manage medications for their older adult care recipients by identifying the activities involved in medication management and the tools or strategies used to facilitate these activities. METHODS Four focus groups with caregivers of older adults were conducted with 5-9 caregivers per group. Participants were asked to describe the medication management activities performed and the tools or strategies used to facilitate these activities. Focus groups were recorded, transcribed verbatim, and analyzed for themes using an inductive approach. RESULTS Caregivers were commonly involved in 2 types of activities: direct activities requiring physical handling of medications such as obtaining medications, preparing pill boxes, and assisting with medication administration; and indirect activities that were more complex and required more of a cognitive effort by the caregiver, such as organizing and tracking medications, gathering information, and making treatment decisions. They utilized a variety of tools and strategies to support these medication management activities; however, these approaches often needed to be modified or personalized to meet the specific needs of their caregiving situation. CONCLUSIONS Informal caregivers play a vital role in ensuring safe and appropriate medication use by older adults. Medication management is complex and involves many activities that are supported through the use of a variety of tools and strategies that have been adapted and individualized to each specific caregiving scenario. Caregivers should be an important component of interventions that aim to improve medication use among older adults.
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Affiliation(s)
- Kevin A Look
- Social and Administrative Sciences Division, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Ave., Madison, WI, 53705-2222, USA.
| | - Jamie A Stone
- Social and Administrative Sciences Division, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Ave., Madison, WI, 53705-2222, USA
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