Medication Persistence Rates and Factors Associated with Persistence in Patients Following Stroke: A Cohort Study
Open Access
- 10 July 2008
- journal article
- Published by Springer Science and Business Media LLC in BMC Neurology
- Vol. 8 (1), 25
- https://doi.org/10.1186/1471-2377-8-25
Abstract
Medication nonadherence can be as high as 50% and results in suboptimal patient outcomes. Stroke patients in particular can benefit from pharmacotherapy for thrombosis, hypertension, and dyslipidemia but are at high risk for medication nonpersistence. Patients who were admitted to the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, with stroke between January 1, 2001 and December 31, 2002 were analyzed. Data collected were pre-stroke function, stroke subtype, stroke severity, patient outcomes, and medication use at discharge, and six and 12 months post discharge. Medication persistence at six and 12 months and the factors associated with nonpersistence at six months were examined using multivariable stepwise logistic regression. At discharge, 420 patients (mean age 68.2 years, 55.7% male) were prescribed an average of 6.4 medications and mean prescription drug cost was $167 monthly. Antihypertensive (91%) and antithrombotic (96%) drug use at discharge were frequent, antilipidemic (73%) and antihyperglycemic (25%) drug use were less common. Self-reported persistence at six and 12 months after stroke was high (> 90%) for all categories. In the multivariable model of medication nonpersistence at six months, people aged 65 to 79 years were less likely to be nonpersistent with antihypertensive medications than people aged 80 years or more (Odds ratio (OR) 0.11, 95% Confidence Interval (CI) 0.03–0.39). Monthly drug costs of < $90 or $90–199.99 were associated with greater nonpersistence, compared to monthly drug costs ≥$200 (OR 6.74, 95% CI 1.32–34.46 for < $90; OR 5.25, 95% CI 1.14–24.25 for $90–199.99). For the antithrombotic drug category, people aged 65 to 79 years were less likely to be nonpersistent than people aged 80 years or more (OR 0.23, 95% CI 0.06–0.81), and people who were disabled before admission were more likely to be nonpersistent than those not disabled (OR 7.01, 95% CI 1.66–29.58). Patients reported high medication persistence rates six and 12 months after stroke. Identification of factors associated with nonpersistence (such as older age and prior disability) will help predict which patients are at higher risk for discontinuing their medications.Keywords
This publication has 38 references indexed in Scilit:
- Discontinuation of Statin Therapy and Clinical Outcome After Ischemic StrokeStroke, 2007
- In-Hospital Initiation of Secondary Stroke Prevention Therapies Yields High Rates of Adherence at Follow-upStroke, 2004
- Medication non-adherence in the elderly - How big is the problem?Drugs & Aging, 2003
- Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patientsBMJ, 2002
- Compliance With Secondary Prevention of Ischemic StrokeStroke, 2001
- Preventing Ischemic Stroke in Patients With Prior Stroke and Transient Ischemic AttackStroke, 1999
- How Do Stroke Units Improve Patient Outcomes?Stroke, 1997
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke, 1989
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke, 1988
- Development and validation of a geriatric depression screening scale: A preliminary reportJournal of Psychiatric Research, 1983