International Journal of Clinical Pharmacy

, Volume 39, Issue 5, pp 1008–1012 | Cite as

Design and application of a medication assessment tool for secondary prevention of stroke

  • Marise GauciEmail author
  • Francesca Wirth
  • Liberato Camilleri
  • Lilian M. Azzopardi
  • Anthony Serracino-Inglott
Short Research Report


Background Optimisation of drug therapy is essential in the care of older persons and may be facilitated by application of medication assessment tools (MATs). Objective To design, psychometrically evaluate and apply an innovative MAT for secondary prevention of ischaemic stroke with particular relevance to older persons. Method Review criteria were selected from clinical practice guidelines and MAT-CVA was developed, validated and tested for reliability and feasibility. MAT-CVA was applied to 150 patients with a diagnosis of ischaemic stroke or transient ischaemic attack admitted to a rehabilitation hospital. Results MAT-CVA consists of 17 criteria sectioned into antithrombotic, lipid lowering, antihypertensive and glycaemic therapy. Content validity was demonstrated for all criteria. Reliability was confirmed with kappa values of 0.80 for both inter- and intraobserver agreements. Mean application time for the two observers was 5.55 and 6.56 min. Adherence to applicable criteria was 55% and justified non-adherence was 22.3%. Non-adherence was predominantly evident for prescription of anticoagulation in concurrent atrial fibrillation (36.4%), thiazide diuretics ± angiotensin converting enzyme inhibitors for hypertension (26.8%) and dipyridamole at the recommended dose (24.0%). Conclusion Application of MAT-CVA indicated good overall adherence and identified gaps in clinical performance which may be targeted to enhance drug therapy optimisation.


Elderly Ischaemic stroke Medication assessment tool Quality of care 



The authors would like to thank the consultant geriatricians, consultant neurologists and clinical pharmacists who participated in the validity, reliability and feasibility testing.


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflicts of interest

The authors declare that they have no conflict of interest to disclose.

Supplementary material

11096_2017_515_MOESM1_ESM.pdf (16 kb)
Supplementary material 1 (PDF 15 kb)


  1. 1.
    Page RL, Linnebur SA, Bryant LL, Ruscin JM. Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clin Interv Aging. 2010;5:75–87.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Zulman DM, Asch SM, Martins SB, Kerr EA, Hoffman BB, Goldstein MK. Quality of care for patients with multiple chronic conditions: the role of comorbidity interrelatedness. J Gen Intern Med. 2013;29(3):529–37.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    McAnaw JJ, Hudson S, McGlynn S. Development of an evidence-based medication assessment tool to demonstrate the quality of drug therapy use in patients with heart failure. Pharm World Sci. 2003;11(Suppl):R17.Google Scholar
  4. 4.
    Liu H, Chen H, Johnson J, Lin Y. A medication assessment tool to evaluate adherence to medication guideline in asthmatic children. Int J Clin Pharm. 2013;35(2):289–95.CrossRefPubMedGoogle Scholar
  5. 5.
    Garcia BH, Smabrekke L, Trovik T, Giverhaug T. Application of the MAT-CHDSP to assess guideline adherence and therapy goal achievement in secondary prevention of coronary heart disease after percutaneous coronary intervention. Eur J Clin Pharmacol. 2013;69(3):703–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Hogli JU, Smabrekke L, Garcia BH. MAT-CAP: a novel medication assessment tool to explore adherence to clinical practice guidelines in community-acquired pneumonia. Pharmacoepidemiol Drug Saf. 2014;23(9):933–41.CrossRefPubMedGoogle Scholar
  7. 7.
    Grech L, Ferrito V, Serracino Inglott A, Azzopardi LM. Development and validation of RhMAT, as medication assessment tool specifically designed for rheumatoid arthritis management. JPHSR. 2016;7(1):89–92.Google Scholar
  8. 8.
    Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischaemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236.CrossRefPubMedGoogle Scholar
  9. 9.
    National Institute for Health and Care Excellence. Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events: Technology appraisal 210. 2010. Accessed 9 February 2017.
  10. 10.
    Royal College of Physicians Intercollegiate Stroke Working Party. National clinical guideline for stroke. Royal College of Physicians. 2012. Accessed 9 February 2017.

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Pharmacy, Faculty of Medicine and SurgeryUniversity of MaltaMsidaMalta
  2. 2.Department of PharmacyRehabilitation Hospital Karin GrechPietaMalta
  3. 3.Department of Statistics and Operations Research, Faculty of ScienceUniversity of MaltaMsidaMalta

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