Document Detail


Key barriers to medication adherence in survivors of strokes and transient ischemic attacks.
MedLine Citation:
PMID:  23288379     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Even though medications can greatly reduce the risk of recurrent stroke, medication adherence is suboptimal in stroke survivors.
OBJECTIVE: To identify key barriers to medication adherence in a predominantly low-income, minority group of stroke and transient ischemic attack (TIA) survivors.
DESIGN: Cross-sectional study.
PARTICIPANTS: Six hundred stroke or TIA survivors, age ≥ 40 years old, recruited from underserved communities in New York City.
MAIN MEASURES: Medication adherence was measured using the 8-item Morisky Medication Adherence Questionnaire. Potential barriers to adherence were assessed using validated instruments. Logistic regression was used to test which barriers were independently associated with adherence. Models were additionally controlled for age, race/ethnicity, income, and comorbidity.
KEY RESULTS: Forty percent of participants had poor self-reported medication adherence. In unadjusted analyses, compared to adherent participants, non-adherent participants had increased concerns about medications (26 % versus 7 %, p < 0.001), low trust in their personal doctor (42 % versus 29 %, p = 0.001), problems communicating with their doctor due to language (19 % versus 12 %, p = 0.02), perceived discrimination from the health system (42 % versus 22 %, p < 0.001), difficulty accessing health care (16 % versus 8 %, p = 0.002), and inadequate continuity of care (27 % versus 20 %, p = 0.05). In the fully adjusted model, only increased concerns about medications [OR 5.02 (95 % CI 2.76, 9.11); p < 0.001] and perceived discrimination [OR 1.85 (95 % CI 1.18, 2.90); p = 0.008] remained significant barriers.
CONCLUSIONS: Increased concerns about medications (related to worry, disruption, long-term effects, and medication dependence) and perceived discrimination were the most important barriers to medication adherence in this group. Interventions that reduce medication concerns have the greatest potential to improve medication adherence in low-income stroke/TIA survivors.
Authors:
Ian M Kronish; Michael A Diefenbach; Donald E Edmondson; L Alison Phillips; Kezhen Fei; Carol R Horowitz
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-04
Journal Detail:
Title:  Journal of general internal medicine     Volume:  28     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-22     Completed Date:  2013-11-22     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  675-82     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cross-Sectional Studies
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility / statistics & numerical data
Humans
Ischemic Attack, Transient / prevention & control*,  psychology
Male
Medically Underserved Area
Medication Adherence / psychology,  statistics & numerical data*
Middle Aged
New York City
Professional-Patient Relations
Psychometrics
Recurrence / prevention & control
Socioeconomic Factors
Stroke / prevention & control*,  psychology
Survivors / psychology
Grant Support
ID/Acronym/Agency:
K23 HL098359/HL/NHLBI NIH HHS; K23 HL098359/HL/NHLBI NIH HHS; P60MD00270/MD/NIMHD NIH HHS; UL1 TR000040/TR/NCATS NIH HHS; UL1RR029887/RR/NCRR NIH HHS
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