Continuation and adherence rates on initially-prescribed intensive secondary prevention therapy after Rapid Access Stroke Prevention (RASP) service assessment

Stephen J.X. Murphy, Catherine A. Coughlan, William Tobin, Justin Kinsella, Roisin Lonergan, Myles Gutkin, Dominick J.H. McCabe

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Introduction Consistent adherence to treatment is essential for effective secondary prevention following TIA/ischaemic stroke. Representative data on long-term treatment continuation and adherence rates are limited. Methods This single centre study recruited patients attending our Rapid Access Stroke Prevention clinic in Ireland from 07/09/2006 → 30/11/2009. Demographic and clinical data, and prescribed medication regimens at initial assessment were recorded. All patients received copies of clinical correspondence containing clear 'goal-directed treatment advice' sent to their general practitioner or referring physician. Patients were subsequently interviewed with a standardised pro-forma to assess continuation and adherence rates; overall adherence rates with secondary prevention therapy were also assessed with a validated self-reporting tool (Morisky Scale). Recurrent vascular events during follow-up were recorded. Results One hundred and fourteen patients were recruited; mean age: 64.5 ± 13.8 years; median duration of follow-up: 630 days. Patients were prescribed aspirin (69.3%), alone (17.5%) or in combination with dipyridamole MR (51.8%), clopidogrel (18.2%), warfarin (16.7%), statins (76.3%) and anti-hypertensives (51.8%). During follow-up, the percentages of patients continuing treatment prescribed at the initial visit were: Aspirin (93.7%), dipyridamole MR (72.9%), clopidogrel (81%), warfarin (94.7%), statins (87.9%) and anti-hypertensives (89.8%). Overall, 99.1% reported taking their medication the preceding day. Morisky scale scores for all treatments revealed that 41.2% (N = 47) were high, 36.8% (N = 42) medium, and 12.3% (N = 14) low adherers; 9.7% (N = 11) had incomplete data. Two patients (1.8%) had recurrent cerebrovascular events, and two (1.8%) had myocardial infarctions. Discussion This novel study in European TIA/ischaemic stroke patients, who were provided with a goal-directed secondary prevention plan, showed high rates of medication-continuation and self-reported adherence with prescribed treatment, associated with a low incidence of recurrent vascular events during a median follow up of 1.7 years.

Original languageEnglish (US)
Pages (from-to)13-18
Number of pages6
JournalJournal of the Neurological Sciences
Volume361
DOIs
StatePublished - Feb 15 2016

Keywords

  • Adherence
  • Compliance
  • Continuation rates
  • Ischaemic stroke
  • Morisky scale
  • TIA

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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