Document Detail


Secondary preventive medication persistence and adherence 1 year after stroke.
MedLine Citation:
PMID:  21900638     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Data on long-term use of secondary prevention medications following stroke are limited. The Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) Registry assessed patient, provider, and system-level factors influencing continuation of prevention medications for 1 year following stroke hospitalization discharge.
METHODS: Patients with ischemic stroke or TIA discharged from 106 hospitals participating in the American Heart Association Get With The Guidelines-Stroke program were surveyed to determine their use of warfarin, antiplatelet, antihypertensive, lipid-lowering, and diabetes medications from discharge to 12 months. Reasons for stopping medications were ascertained. Persistence was defined as continuation of all secondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribed medications except those stopped according to health care provider instructions.
RESULTS: Of the 2,880 patients enrolled in AVAIL, 88.4% (2,457 patients) completed 1-year interviews. Of these, 65.9% were regimen persistent and 86.6% were regimen adherent. Independent predictors of 1-year medication persistence included fewer medications prescribed at discharge, having an adequate income, having an appointment with a primary care provider, and greater understanding of why medications were prescribed and their side effects. Independent predictors of adherence were similar to those for persistence.
CONCLUSIONS: Although up to one-third of stroke patients discontinued one or more secondary prevention medications within 1 year of hospital discharge, self-discontinuation of these medications is uncommon. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions.
Authors:
C D Bushnell; D M Olson; X Zhao; W Pan; L O Zimmer; L B Goldstein; M J Alberts; S C Fagan; G C Fonarow; S C Johnston; C Kidwell; K A Labresh; B Ovbiagele; L Schwamm; E D Peterson;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-09-07
Journal Detail:
Title:  Neurology     Volume:  77     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-20     Completed Date:  2011-11-08     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1182-90     Citation Subset:  AIM; IM    
Affiliation:
Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. cbushnel@wakehealth.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Cohort Studies
Female
Follow-Up Studies
Humans
Longitudinal Studies
Male
Medication Adherence*
Middle Aged
Registries
Secondary Prevention / trends*
Stroke / drug therapy,  epidemiology*,  prevention & control*
Grant Support
ID/Acronym/Agency:
U18HS016964/HS/AHRQ HHS
Investigator
Investigator/Affiliation:
Mark Alberts / ; Bruce Coull / ; Pamela Duncan / ; Susan C Fagan / ; Michael Frankel / ; Larry Goldstein / ; Philip Gorelick / ; S Claiborne Johnston / ; Chelsea Kidwell / ; Kenneth A LaBresh / ; Pamela Mitchell / ; Bruce Ovbiagele / ; Ralph Sacco / ; Lee Schwamm / ; Linda Williams / ; Richard Zorowitz / ; B Franklin Diamond / ; Jenny McGowan / ; Gary Bernardini / ; Linda Graca / ; Wende Fedder / ; Mona Olges / ; Terri Nielsen / ; John Andrefsky / ; Judy Werstler / ; John Wulff / ; David Bear / ; Tammie Stefanko / ; Doreen Donohue / ; Michelle Silver / ; John Gannon / ; Andrea Hrin / ; Sandy Nylu / ; Alec Kloman / ; Deborah Jewell / ; Thomas Kelly / ; Dan Rodriguez / ; Bobbie Nolan / ; Vicki Hanselman / ; James Bobenhouse / ; Kathy Ware / ; Donna Falwell / ; Henry Echiverri / ; Elias Gizaw / ; Wanda Shaver / ; Harry Reahl / ; Deborah Rectenwald / ; Karen McCuaig / ; Debbie Ferguson / ; Alfred Bowles / ; Monica Updyke / ; Gina Briscoe / ; Amy Foster / ; Cindy Wagner / ; Donna Seif / ; Tang Kejan / ; Rose Watroba / ; Michael O'Brien / ; Sherry Wirt / ; Kathy Sciarappa / ; Pamela Petry / ; Betty Brown / ; Chere Chase / ; Gwen Ainsworth / ; James DeMatteis / ; Patty Henry / ; Sheri Muska / ; Scott Hitchcock / ; Mary Brethour / ; Jaci Phillips / ; Stephen J Martino / ; Alison Trembly / ; Christopher Sinclair / ; Lori Blom / ; Kent Taub / ; Allison Rico / ; Eileen Allosso / ; Claudia Fitzgerald / ; Joan Vance / ; Paul Ash / ; Jean Carlton / ; Paul Ash / ; Jean Carlton / ; Randolph Shey / ; Angie West / ; Michael Schneck / ; Linda Chadwick / ; Lisa Guyll / ; Karen Yarbrough / ; Lee Schwamm / ; Ahsan Pervez / ; Brenda Hogan / ; Sandra Studebaker / ; Patricia Farrell / ; Victoria Lindemann / ; Nicki Roderman / ; Michel Torbey / ; Erin Brandenburg / ; Gretchen Tietjen / ; Andrea Korsnack / ; Jennifer Pary / ; Deb Motz / ; Jennifer Pary / ; Diane Handler / ; Mark Young / ; Deb Motz / ; Mark Young / ; Diane Handler / ; Joseph Hanna / ; Dana Cook / ; Ajay Arora / ; Teresa Jones / ; Janice Ulmer / ; Tricia Westbrook / ; Amanda Grindle / ; David Hart / ; Christine Ball / ; David Hart / ; Christine Ball / ; Roger Gietzen / ; Elaine Siwiec / ; Stephen Martino / ; Jane Kaiser / ; Fen-Lei Chang / ; Lynn Wilton / ; Raymond Reichwein / ; Judy Dillon / ; Marie Welch / ; Aris Chaconas / ; Amy Holland / ; Julie McDonald / ; Stephanie Abbott / ; Walter Bohnenblust / ; Ruth Bailey / ; Paul Katz / ; Nicholas Green / ; Noah Gilson / ; Rebecca Graboso / ; W Scott Burgin / ; Cheryl Weber / ; Shyam Prabhakaran / ; Susan Dvojack / ; Richard Smith / ; Christine Potzer / ; Teri Kozik / ; Judith Brady / ; Michael Kaminski / ; Deb Pitts / ; Michelle VanDemark / ; Adrian Goldszmidt / ; Kathleen Birnbaum / ; Margaret Tremwel / ; Cheryl Hyde / ; Wende Fedder / ; Mona Olges / ; Susan Hickenbottom / ; Kimberly Gray / ; Carl McComas / ; Jennifer Edwards / ; Steve Erlemeier / ; Jennifer Gottschald / ; Lee Vanderburgh / ; Nancy J Newkirk / ; Srinath Kadimi / ; Jennifer Nascimento / ; Robert Lada / ; Jan Weinhardt / ; Kyle Malone / ; William Likosky / ; Jeannie Bush / ; Pierre Fayad / ; Mary Phillips / ; Deborah Green / ; Lyle Oshita / ; Deborah Green / ; Bruce Ovbiagele / ; Sandra Pineda / ; Mehari Gebreyohanns / ; Cindy Hoff / ; Kerri Remmel / ; Elizabeth Wise / ; Larry Wechsler / ; Sharon DeCesare / ; Jeanne Robinson / ; Nancy Wiech / ; Ash Jain / ; Douglas Van Houten / ; Stephen Marks / ; Kathryn D'Aquila / ; David Wheeler / ; Marta Jimenez / ; Brenda Chapman /
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