title: Multimodal Interventions to Enhance Adherence to Secondary Preventive Medication after Stroke: A Systematic Review and Meta-Analyses.
abstract: BACKGROUND
  Nonadherence to secondary preventative medications after stroke is common and is associated with poor outcomes. Numerous strategies exist to promote adherence. We performed a systematic review and meta-analysis to describe the efficacy of strategies to improve adherence to stroke secondary prevention.
  
  
  METHODS
  We created a sensitive search strategy and searched multiple electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, and Web of Knowledge) for studies of interventions that aimed to enhance adherence to secondary preventative medication after stroke. We assessed quality of included studies using the Cochrane tool for assessing risk of bias. We performed narrative review and performed meta-analysis where data allowed.
  
  
  RESULTS
  From 12,237 titles, we included seventeen studies in our review. Eleven studies were considered to have high risk of bias, 3 with unclear risk, and 3 of low risk. Meta-analysis of available data suggested that these interventions improved adherence to individual medication classes (blood pressure-lowering drugs - OR, 2.21; 95% CI (1.63, 2.98), [P < 0.001], lipid-lowering drugs - OR, 2.11; 95% CI (1.00, 4.46), [P = 0.049], and antithrombotic drugs - OR, 2.32; 95% CI (1.18, 4.56, [P = 0.014]) but did not improve adherence to an overall secondary preventative medication regimen (OR, 1.96; 95% CI (0.50, 7.67), [P = 0.332]).
  
  
  CONCLUSIONS
  Interventions can lead to improvement in adherence to secondary preventative medication after stroke. However, existing data is limited as several interventions, duration of follow-up, and various definitions were used. These findings need to be interpreted with caution.
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Sukainah
authors.initials: S
authors.lastname: Al AlShaikh
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Terry
authors.initials: T
authors.lastname: Quinn
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: William
authors.initials: W
authors.lastname: Dunn
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Walters
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Jesse
authors.initials: J
authors.lastname: Dawson
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006401:Hematologic Agents / Q000627:therapeutic use*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D055118:Medication Adherence; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D000959:Antihypertensive Agents; D006401:Hematologic Agents; D000960:Hypolipidemic Agents
keywords: Adherence; Intervention; Prevention; Secondary; Stroke; TIA