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The effect of a locally adapted, secondary stroke risk factor self-management program on medication adherence among veterans with stroke/TIA

  • Original Research
  • Published:
Translational Behavioral Medicine

An Erratum to this article was published on 27 May 2016

Abstract

We targeted stroke/transient ischemic attack (TIA) survivors to engage in self-management practices to manage secondary stroke risk factors. We conducted a randomized, regional pilot trial of a locally adapted, secondary stroke prevention program. We implemented the program at two Veterans Administration Medical Centers. Program sessions targeted stroke risk factor self-management. Specifically, we evaluated the effect of the program on the reach, implementation, and effectiveness on patient self-efficacy; stroke-specific, health-related quality of life; and medication adherence for the prevalent stroke risk factors: (1) diabetes, (2) hypertension, and (3) hyperlipidemia. Medication possession ratios were calculated to evaluate medication adherence using VA pharmacy benefits data pre (6 months prior) and post (6 months after) the stroke/TIA event. Based upon the literature standard of 80 % compliance rate, we dichotomized compliance and modeled the data using logistical regression. Final sample included 174 veterans with an acute stroke or TIA who were randomized to receive either the intervention (n = 87) or attention control program (n = 87). Patient self-efficacy and stroke-specific, health-related quality of life at 6 months did not significantly differ between groups. We found improvements in medication adherence within the intervention group. In the intervention group, the odds of compliance with diabetes medications post-stroke were significantly larger than the odds of compliance prior to the stroke (odds ratio = 3.45 (95 % CI = 1.08–10.96). For compliance to hypertension medications, the intervention group showed significantly greater odds of compliance post intervention than pre intervention (odds ratio = 3. 68 (95 % CI = 1.81–7.48). The control group showed no difference in compliance rates from baseline to follow-up. For adherence to hypercholesterolemia medications, both the intervention (odds ratio = 5.98 (95 % CI = 2.81–12.76) and control groups (odds ratio = 3.83 (95 % CI = 1.83–8.01), had significant increases in the odds of compliance to statin medications; however, the comparison of changes in log odds of compliance between these two groups showed that the increases were not significantly different. We observed within group improvements in medication adherence among those receiving a post-stroke risk factor self-management program suggesting that a self-management format may be feasible to enable adherence to prescribed medications to reduce secondary stroke risk after stroke in concordance with guideline care. Additional research is needed to enhance intervention components to improve effectiveness outcomes.

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Acknowledgments

This study was funded by the VA HSRD Investigator Initiated Research Grant IAB 05-297-2 and by the HSRD VA Stroke QUERI Center. The trial registration number is Current Clinical Trials NCT00355147. We thank the veteran participants and the staff at the VA Medical Centers for their time spent on this project.

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Authors and Affiliations

  1. VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA

    Teresa M. Damush Ph.D., Laura Myers Ph.D., Zhangsheng Yu Ph.D., Susan Ofner M.S., Gloria Nicholas R.N., Barbara Kimmel M.S., Arlene A. Schmid Ph.D., O.T.R. & Linda S. Williams M.D.

  2. VA HSRD Coin Center, Michael DeBakey VAMC, Baylor College of Medicine, Houston, TX, USA

    Jane A. Anderson Ph.D., A.N.P. & Thomas Kent M.D.

Authors
  1. Teresa M. Damush Ph.D.
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  2. Laura Myers Ph.D.
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  3. Jane A. Anderson Ph.D., A.N.P.
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  4. Zhangsheng Yu Ph.D.
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  5. Susan Ofner M.S.
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  6. Gloria Nicholas R.N.
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  7. Barbara Kimmel M.S.
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  8. Arlene A. Schmid Ph.D., O.T.R.
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  9. Thomas Kent M.D.
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  10. Linda S. Williams M.D.
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Corresponding author

Correspondence to Teresa M. Damush Ph.D..

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The authors declare that they have no competing interests.

Additional information

Implications

Policy: Nursing work tasks should be allocated for patient education to foster self-management practices during post-acute stroke care.

Research: Medication possession ratios from pharmacy data may serve as objective medication adherence outcomes.

Practice: Inclusion of medication adherence strategies during post-acute stroke care including how to refill, and strategies for adhering to prescriptions may improve patient adherence.

Appendices

Appendix A

Table 5 List of medications in VHA PBM prescribed for clinical conditions: diabetes, hypercholesterolemia, and hypertension
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Appendix B

Table 6 Intervention content delivery fidelity
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Appendix C

Table 7 Common reported patient goals for stroke self-management
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Damush, T.M., Myers, L., Anderson, J.A. et al. The effect of a locally adapted, secondary stroke risk factor self-management program on medication adherence among veterans with stroke/TIA. Behav. Med. Pract. Policy Res. 6, 457–468 (2016). https://doi.org/10.1007/s13142-015-0348-6

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  • DOI: https://doi.org/10.1007/s13142-015-0348-6

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