The Compliance of Stroke Patients for Secondary Prevention: In Seoul & Kyunggi province

Koh, Im Seok; Kim, Hyung Chul; Kwon, Seok Beom; Whang, Sung Hee; Kwon, Ki Han; Kim, Sung Min; Song, Hong Ki; Lee, Byung Chul

Abstract

BACKGROUND: The secondary prevention of stroke which is defined as the control of risk factors and continuous antithrombotic therapy if indicated plays an important role in decreasing stroke recurrence. Unlike most developed countries, the stroke mortality in Korea has yet to be on the decline. It is well known that treatment non-compliance for secondary prevention after a stroke is associated with stroke recurrence and poor functional outcome. There has been no investigation about outpatient treatment compliance of Korean stroke patients who were previously hospitalized. This study aimed to explore the behavior and preference for treatment of stroke patients after discharge and to assess the recurrence rate of stroke for those patients who were not compliant with therapy for secondary prevention and their reasons for not being compliant.
METHODS
Study subjects included three hundred thirty-eight stroke patients who were admitted to the Hallym Stroke Center between Jan. 1 and Dec. 31 of 1995. Those who died during hospitalization and those who were discharged to go home on impending death were excluded. The mean age was 63.6 years and the male to female ratio was 1.2 to 1. Telephone inquiries were performed with patients or caregivers regarding the recurrence of stroke, the reasons for non-compliance with secondary preventive management and other kinds of care they received for stroke.
RESULTS
Among two hundred six patients (60.9%) not given a follow up on the out-patient basis, 110 patients completed telephone interviews and 102 patients were found to be non-compliant. Nineteen patients (17.7 %) of this non-compliant group reportedly had a recurrent stroke. The age, level of education, and Rankin score were factors which influenced the compliance of patients. Non-compliant patients were currently under the care of: 1) oriental medicine and/or acupuncture (n=56); 2) alternative medicine (n=17); 3) inadvertent over-the-counter drugs (n=16); and 4) no treatment at all (n=26). The reasons for non-compliance included: 1) biased preponderance of oriental medicine (n=44); 2) ignorance about the importance of secondary prevention (n=36); 3) inconvenience of the bureaucratic procedure of hospitals (n=34); 4) economic burden (n=17); 5) dissatisfaction with medical care (n=10); and 6) other reasons (n=6).
CONCLUSIONS
Secondary prevention care for Korean stroke patients seems to be inadequately achieved. The proper education of patients and their caregivers about the importance for the secondary prevention of stroke is needed to decrease stroke recurrence in Korea.