title: Nurse-Led Intervention to Improve Knowledge of Medications in Survivors of Stroke or Transient Ischemic Attack: A Cluster Randomized Controlled Trial.
abstract: BACKGROUND
  Limited evidence exists on effective interventions to improve knowledge of preventive medications in patients with chronic diseases, such as stroke. We investigated the effectiveness of a nurse-led intervention, where a component was to improve knowledge of prevention medications, in patients with stroke or transient ischemic attack (TIA).
  
  
  METHODS
  Prospective sub-study of the Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management, a randomized controlled trial of risk factor management. We recruited patients aged ≥18 years and hospitalized for stroke/TIA. The intervention comprised an individualized management program, involving nurse-led education, and management plan with medical specialist oversight. The outcome, participants' knowledge of secondary prevention medications at 12 months, was assessed using questionnaires. A score of ≥5 was considered as good knowledge. Effectiveness of the intervention on knowledge of medications was determined using logistic regression.
  
  
  RESULTS
  Between May 2014 and January 2015, 142 consecutive participants from the main trial were included in this sub-study, 64 to usual care and 78 to the intervention (median age 68.9 years, 68% males, and 79% ischemic stroke). In multivariable analyses, we found no significant difference between intervention groups in knowledge of medications. Factors independently associated with good knowledge (score ≥5) at 12 months included higher socioeconomic position (OR 4.79, 95% CI 1.76, 13.07), greater functional ability (OR 1.69, 95% CI 1.17, 2.45), being married/living with a partner (OR 3.12, 95% CI 1.10, 8.87), and using instructions on pill bottle/package as an administration aid (OR 4.82, 95% CI 1.76, 13.22). Being aged ≥65 years was associated with poorer knowledge of medications (OR 0.24, 95% CI 0.08, 0.71), while knowledge was worse among those taking three medications (OR 0.15, 95% CI 0.03, 0.66) or ≥4 medications (OR 0.09, 95% CI 0.02, 0.44), when compared to participants taking fewer (≤2) prevention medications.
  
  
  CONCLUSIONS
  There was no evidence that the nurse-led intervention was effective for improving knowledge of secondary prevention medications in patients with stroke/TIA at 12 months. However, older patients and those taking more medications should be particularly targeted for more intensive education.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ACTRN12688000166370).
authors.affiliation: Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University , Clayton, VIC , Australia.
authors.forename: Muideen T
authors.initials: MT
authors.lastname: Olaiya
authors.affiliation: Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
authors.affiliation: Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.
authors.forename: Joosup
authors.initials: J
authors.lastname: Kim
authors.affiliation: Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University , Clayton, VIC , Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ung
authors.affiliation: Menzies Institute for Medical Research, Hobart, TAS, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Nelson
authors.affiliation: Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Menzies Institute for Medical Research, Hobart, TAS, Australia.
authors.forename: Velandai K
authors.initials: VK
authors.lastname: Srikanth
authors.affiliation: Department of Neurosciences, Box Hill Hospital , Box Hill, VIC , Australia.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Bladin
authors.affiliation: Department of Medicine, Epworth Healthcare , Richmond, VIC , Australia.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Gerraty
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University , Melbourne, VIC , Australia.
authors.forename: Sharyn M
authors.initials: SM
authors.lastname: Fitzgerald
authors.affiliation: Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University , Clayton, VIC , Australia.
authors.forename: Thanh G
authors.initials: TG
authors.lastname: Phan
authors.affiliation: Department of Neurology, Alfred Hospital , Prahan, VIC , Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Frayne
authors.affiliation: Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University , Clayton, VIC , Australia.
authors.forename: Amanda G
authors.initials: AG
authors.lastname: Thrift
keywords: nursing intervention; patient medication knowledge; randomized controlled trial; secondary prevention; stroke