title: Continuation and adherence rates on initially-prescribed intensive secondary prevention therapy after Rapid Access Stroke Prevention (RASP) service assessment.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland; Department of Stroke Service, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
authors.forename: Stephen J X
authors.initials: SJ
authors.lastname: Murphy
authors.affiliation: Department of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Coughlan
authors.affiliation: Department of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland; Department of Stroke Service, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland; Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Oliver
authors.initials: O
authors.lastname: Tobin
authors.affiliation: Department of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland; Department of Stroke Service, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland; Dementia Research Centre, University College London, London, UK.
authors.forename: Justin
authors.initials: J
authors.lastname: Kinsella
authors.affiliation: Department of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
authors.forename: Roisin
authors.initials: R
authors.lastname: Lonergan
authors.affiliation: Department of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
authors.forename: Myles
authors.initials: M
authors.lastname: Gutkin
authors.affiliation: Department of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland; Department of Stroke Service, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland; Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK; Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland. Electronic address: dominick.mccabe@amnch.ie.
authors.forename: Dominick J H
authors.initials: DJ
authors.lastname: McCabe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002545:Brain Ischemia / Q000453:epidemiology / Q000517:prevention & control*; D000077144:Clopidogrel; D004176:Dipyridamole / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012008:Recurrence; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D014859:Warfarin; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Adherence; Compliance; Continuation rates; Ischaemic stroke; Morisky scale; TIA