title: Stroke survivors', caregivers' and GPs' attitudes towards a polypill for the secondary prevention of stroke: a qualitative interview study.
abstract: To understand the perspectives of stroke survivors, caregivers and general practitioners (GPs) on a polypill approach, consisting of blood pressure and cholesterol-lowering therapies, with or without aspirin, for the secondary prevention of stroke.
  
  
  
  A qualitative interview study was undertaken in 5 GP surgeries in the East of England. 28 survivors of stroke/transient ischaemic attack (TIA) were interviewed, 14 of them with a caregiver present, along with a convenience sample of 5 GPs, to assess attitudes towards a polypill and future use. Topic guides explored participants attitudes, potential uptake and long-term use, management of polypill medication and factors influencing the decision to prescribe. Data were analysed using a grounded theory approach. Key themes are presented and illustrated with verbatim quotes.
  
  
  
  The analysis identified 3 key themes: polypill benefits, polypill concerns and polypill lessons for implementation. Stroke/TIA survivors were positive about the polypill concept and considered it acceptable in the secondary prevention of stroke. Perceived benefits of a polypill included convenience resulting in improved adherence and reduced burden of treatment. Caregivers felt that a polypill would improve medication-taking practices, and GPs were open to prescribing it to those at increased cardiovascular risk. However, concerns raised included whether a polypill provided equivalent therapeutic benefit, side effects through combining medications, consequences of non-adherence, lack of flexibility in regulating dosage, disruption to current treatment and suitability to the wider stroke population.
  
  
  
  Participants acknowledged potential advantages in a polypill approach for secondary prevention of stroke; however, significant concerns remain. Further research on the efficacy of a polypill is needed to reassure practitioners whose concerns around inflexibility and treatment suitability are likely to influence the decision to prescribe a polypill for secondary prevention of stroke. Acceptability among survivors, caregivers and GPs is likely to determine the uptake and subsequent use of a polypill in the future.
authors.affiliation: Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: James
authors.initials: J
authors.lastname: Jamison
authors.affiliation: Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Graffy
authors.affiliation: Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.
authors.forename: Ricky
authors.initials: R
authors.lastname: Mullis
authors.affiliation: Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.affiliation: Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sutton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017028:Caregivers / Q000523:psychology; D005260:Female; D058005:General Practitioners / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D036301:Qualitative Research; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000517:prevention & control*; D017741:Survivors
chemical_list: D002317:Cardiovascular Agents
keywords: PRIMARY CARE; QUALITATIVE RESEARCH; STROKE MEDICINE