title: The effect of a locally adapted, secondary stroke risk factor self-management program on medication adherence among veterans with stroke/TIA.
abstract: We targeted stroke/transient ischemic attack (TIA) survivors to engage in self-management practices to manage secondary stroke risk factors. We conducted a randomized, regional pilot trial of a locally adapted, secondary stroke prevention program. We implemented the program at two Veterans Administration Medical Centers. Program sessions targeted stroke risk factor self-management. Specifically, we evaluated the effect of the program on the reach, implementation, and effectiveness on patient self-efficacy; stroke-specific, health-related quality of life; and medication adherence for the prevalent stroke risk factors: (1) diabetes, (2) hypertension, and (3) hyperlipidemia. Medication possession ratios were calculated to evaluate medication adherence using VA pharmacy benefits data pre (6 months prior) and post (6 months after) the stroke/TIA event. Based upon the literature standard of 80 % compliance rate, we dichotomized compliance and modeled the data using logistical regression. Final sample included 174 veterans with an acute stroke or TIA who were randomized to receive either the intervention (n = 87) or attention control program (n = 87). Patient self-efficacy and stroke-specific, health-related quality of life at 6 months did not significantly differ between groups. We found improvements in medication adherence within the intervention group. In the intervention group, the odds of compliance with diabetes medications post-stroke were significantly larger than the odds of compliance prior to the stroke (odds ratio = 3.45 (95 % CI = 1.08-10.96). For compliance to hypertension medications, the intervention group showed significantly greater odds of compliance post intervention than pre intervention (odds ratio = 3. 68 (95 % CI = 1.81-7.48). The control group showed no difference in compliance rates from baseline to follow-up. For adherence to hypercholesterolemia medications, both the intervention (odds ratio = 5.98 (95 % CI = 2.81-12.76) and control groups (odds ratio = 3.83 (95 % CI = 1.83-8.01), had significant increases in the odds of compliance to statin medications; however, the comparison of changes in log odds of compliance between these two groups showed that the increases were not significantly different. We observed within group improvements in medication adherence among those receiving a post-stroke risk factor self-management program suggesting that a self-management format may be feasible to enable adherence to prescribed medications to reduce secondary stroke risk after stroke in concordance with guideline care. Additional research is needed to enhance intervention components to improve effectiveness outcomes.
authors.affiliation: VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA. tdamush@iupui.edu.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Damush
authors.affiliation: VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Myers
authors.affiliation: VA HSRD Coin Center, Michael DeBakey VAMC, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Anderson
authors.affiliation: VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA.
authors.forename: Zhangsheng
authors.initials: Z
authors.lastname: Yu
authors.affiliation: VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Ofner
authors.affiliation: VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA.
authors.forename: Gloria
authors.initials: G
authors.lastname: Nicholas
authors.affiliation: VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kimmel
authors.affiliation: VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA.
authors.forename: Arlene A
authors.initials: AA
authors.lastname: Schmid
authors.affiliation: VA HSRD Coin Center, Michael DeBakey VAMC, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kent
authors.affiliation: VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D006973:Hypertension; D002546:Ischemic Attack, Transient / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012648:Self Care; D020521:Stroke / Q000517:prevention & control*; D014728:Veterans
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Local adaptation; Medication adherence; Secondary stroke prevention