title: Key barriers to medication adherence in survivors of strokes and transient ischemic attacks.
abstract: BACKGROUND
  Even though medications can greatly reduce the risk of recurrent stroke, medication adherence is suboptimal in stroke survivors.
  
  
  OBJECTIVE
  To identify key barriers to medication adherence in a predominantly low-income, minority group of stroke and transient ischemic attack (TIA) survivors.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Six hundred stroke or TIA survivors, age ≥ 40 years old, recruited from underserved communities in New York City.
  
  
  METHODS
  Medication adherence was measured using the 8-item Morisky Medication Adherence Questionnaire. Potential barriers to adherence were assessed using validated instruments. Logistic regression was used to test which barriers were independently associated with adherence. Models were additionally controlled for age, race/ethnicity, income, and comorbidity.
  
  
  RESULTS
  Forty percent of participants had poor self-reported medication adherence. In unadjusted analyses, compared to adherent participants, non-adherent participants had increased concerns about medications (26 % versus 7 %, p < 0.001), low trust in their personal doctor (42 % versus 29 %, p = 0.001), problems communicating with their doctor due to language (19 % versus 12 %, p = 0.02), perceived discrimination from the health system (42 % versus 22 %, p < 0.001), difficulty accessing health care (16 % versus 8 %, p = 0.002), and inadequate continuity of care (27 % versus 20 %, p = 0.05). In the fully adjusted model, only increased concerns about medications [OR 5.02 (95 % CI 2.76, 9.11); p < 0.001] and perceived discrimination [OR 1.85 (95 % CI 1.18, 2.90); p = 0.008] remained significant barriers.
  
  
  CONCLUSIONS
  Increased concerns about medications (related to worry, disruption, long-term effects, and medication dependence) and perceived discrimination were the most important barriers to medication adherence in this group. Interventions that reduce medication concerns have the greatest potential to improve medication adherence in low-income stroke/TIA survivors.
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA. Ik2293@columbia.edu
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.forename: Michael A
authors.initials: MA
authors.lastname: Diefenbach
authors.forename: Donald E
authors.initials: DE
authors.lastname: Edmondson
authors.forename: L Alison
authors.initials: LA
authors.lastname: Phillips
authors.forename: Kezhen
authors.initials: K
authors.lastname: Fei
authors.forename: Carol R
authors.initials: CR
authors.lastname: Horowitz
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D008507:Medically Underserved Area; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009519:New York City; D011369:Professional-Patient Relations; D011594:Psychometrics; D055502:Secondary Prevention; D012959:Socioeconomic Factors; D020521:Stroke / Q000517:prevention & control* / Q000523:psychology; D017741:Survivors / Q000523:psychology; D016903:Drug Monitoring