J Agric Med Community Health.  2015 Mar;40(1):9-20. 10.5393/JAMCH.2015.40.1.009.

Predictors of Persistence and Adherence with Secondary Preventive Medication in Stroke Patients

• Kim YT
• Park KS
• Bae SG

• KMID: 1975241
• DOI: http://doi.org/10.5393/JAMCH.2015.40.1.009

Abstract

OBJECTIVES
This study aimed to explore the persistence and adherence to secondary preventive medication of stroke patients after discharge and to assess the reasons for persistence and nonadherence.
METHODS
Four hundred twenty-nine patients with stroke were surveyed to determine their behaviors from discharge. 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 according to health care provider instructions.
RESULTS
Of the 429 patients, 86.5% were treatment persistent and 41.2%(non-intentional nonadherence=39.4%, intentional nonadherence=19.4%) were adherent. Independent predictors of persistence included having experience about health education. Independent predictors of non-intentional nonadherence were modified Rankin Scale(mRS) (Exp(B)=2.858, p=0.001) and health education experience (Exp(B)=0.472, p=0.032), and independent predictors of intentional nonadherence were mRS (Exp(B)=2.533, p=0.006), depressive symptoms (Exp(B)=1.113, p=0.016), beliefs about medications questionnaire(necessity, Exp(B)=0.879, p=0.011, concern, Exp(B)=1.098, p=0.019).
CONCLUSIONS
Although up to one-ninth of stroke patients continued secondary prevention medications, nonadherence is common. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions. Specially, interventions to improve adherence should target patients' beliefs about their medication.

Keyword

Stroke; Persistence; Adherence; Belief; Depression

MeSH Terms

Depression
Health Education
Health Personnel
Humans
Secondary Prevention
Stroke*