Analysis of factors affecting adherence to treatment in post-stroke patients

Cover Page

Abstract

Introduction. The effectiveness of secondary stroke prevention depends not only on the prescribed medications but also on patients’ compliance with doctors’ recommendations in general. Adherence to therapy among post-stroke patients remains insufficient. This is due to factors that negatively affect compliance with medical recommendations. Among those factors, post-stroke cognitive impairment deserves particular attention.

Study aim – to identify the main factors that determine adherence to long-term therapy in patients after stroke and to assess the impact of post-stroke cognitive impairment on compliance with medical recommendations.

Materials and methods. A total of 56 patients (mean age 64.67±10.19 years), who experienced a hemispheric ischaemic stroke 6 months ago, were examined. Cognitive function was evaluated using the Montreal Cognitive Assessment tool, the battery of tests to assess frontal dysfunction, drawing and clock copying tests, and tests of phonetic and semantic speech activity. Adherence to long-term therapy after stroke was determined using the Morisky–Green test. We also studied the role of sociodemographic and vascular risk factors, that determine treatment adherence.

Results. More than half (51.8%) of post-stroke patients did not comply with medical recommendations. The main barriers to optimal adherence were the male gender, engagement in physical labour throughout life, and the presence of left ventricular hypertrophy, chronic heart failure or bad health habits. The presence of post-stroke cognitive impairment had a negative impact on the adherence to medical recommendations (r=0.49; p<0.001). The results of the survey showed that regular visits to medical specialists were one of the main requirements for maintaining optimal adherence to treatment. Most patients (59.6%) thought that forgetfulness is a key factor affecting adherence to therapy.

Summary. Treatment adherence should be evaluated in all patients after stroke, especially in those with post-stroke cognitive impairment. The identification and correction of ‘modifiable’ risk factors is a way to increase adherence to treatment

About the authors

Anna N. Bogolepova

Pirogov Russian National Research Medical University

Email: ekaterinakov90@mail.ru
Russian Federation, Moscow

Ekaterina A. Kovalenko

Pirogov Russian National Research Medical University

Author for correspondence.
Email: ekaterinakov90@mail.ru
Russian Federation, Moscow

References

  1. Gusev E.I., Skvortsova V.I., Martynov M.Yu., Kamchatnov P.R. [Cerebral stroke: problems and solutions]. Vestnik RGMU 2006; (4): 28–32. (In Russ.)
  2. Suslina Z.A., Piradov M.A., Domashenko M.A. [Stroke: the review of the problem (15 years after)]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova 2014; 114(11): 5–13. PMID: 25591629. (In Russ.)
  3. Crayton E., Fahey M., Ashworth M. et al. Psychological determinants of medication adherence in stroke survivors: a systematic review of observational studies. Ann Behav Med 2017; 51: 833–845. doi: 10.1007/s12160-017-9906-0. PMID: 28421453.
  4. De Geest S., Sabaté E. Adherence to long-term therapies: evidence for action. Eur J Cardiovasc Nurs 2003; 2: 323. doi: 10.1016/S1474-5151(03)00091-4. PMID: 14667488.
  5. Brown M.T., Bussell J.K. Medication adherence: WHO cares? Mayo Clinic Proc 2011; 86: 304–314. doi: 10.4065/mcp.2010.0575. PMID: 21389250.
  6. McDonnell P.J., Jacobs M.R. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother 2002; 36: 1331–1336. doi: 10.1345/aph.1A333. PMID: 12196047.
  7. Chen P.S., Cheng C.L., Yang Y.H.K., Li Y.H. Statin adherence after ischemic stroke or transient ischemic attack is associated with clinical outcome. Circ J 2016; 80: 731–737. doi: 10.1253/circj.CJ-15-0753. PMID: 26742588.
  8. Mugwano I., Kaddumukasa M., Mugenyi L. et al. Poor drug adherence and lack of awareness of hypertension among hypertensive stroke patients in Kampala, Uganda: a cross sectional study. BMC Res Notes 2016; 9: 3. doi: 10.1186/s13104-015-1830-4. PMID: 26725042.
  9. Sokolova N.Yu. [Adherence to therapy in patients with stable coronary artery disease after various revascularizing operations]. Kardiologiya i serdechno-sosudistaya khirurgiya 2019; 12(1): 25–30. doi: 10.17116/kardio20191201125. (In Russ.)
  10. Kumbhani D.J., Fonarow G.C., Cannon C.P. et al. Predictors of adherence to performance measures in patients with acute myocardial infarction. Am J Med 2013; 126: 74. doi: 10.1016/j.amjmed.2012.02.025. PMID: 22925314.
  11. Jokisalo E., Enlund H., Halonen P. et al. Factors related to poor control of blood pressure with antihypertensive drug therapy. Blood Press 2003; 12: 4955. PMID: 12699136.
  12. Oates D.J., Paasche-Orlow M.K. Health literacy: communication strategies to improve patient comprehension of cardiovascular health. Circulation 2009; 119: 1049–1051. doi: 10.1161/CIRCULATIONAHA.108.818468. PMID: 19237675.
  13. Botelho R.J., Dudrak R. Home assessment of adherence to long-term medication in the elderly. J Fam Pract 1992: 35: 61–66. PMID: 1613477.
  14. Mann D.M., Allegrante J.P., Natarajan S. et al. Predictors of adherence to statins for primary prevention. Cardiovasc Drugs Ther 2007; 21: 311–316. doi: 10.1007/s10557-007-6040-4. PMID: 17665294.
  15. Kim M.T., Han H.R., Hill M.N. et al. Depression, substance use, adherence behaviors, and blood pressure in urban hypertensive black men. Ann Behav Med 2003; 26: 2431. doi: 10.1207/S15324796ABM2601_04. PMID: 12867351.
  16. Foot H., La Caze A., Gujral G., Cottrell N. The necessity-concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis. Patient Educ Couns 2016; 99: 706–717. doi: 10.1016/j.pec.2015.11.004. PMID: 26613666.
  17. Rodriguez F.C.C., Steg P.G., Kubhani D.J. et al. Predictors of long-term adherence to evidence-based cardiovascular disease medications in outpatient with stable atherotrombotic disease: findings from the REACH Registry. Clin Cardiol 2013; 16: 721–727. doi: 10.1002/clc. 22217.
  18. Delamater A.M. Improving patient adherence. Clin Diabetes 2006; 24: 71–77. doi: 10.2337/diaclin.24.2.71.
  19. Lihodey N.V., Kalashnikova M.F., Lihodey E.M., Fadeev V.V. [Analysis of the factors that prevent adherence to treatment in patients with diabetes mellitus and the strategies that contribute to the improvement in adherence]. Diabetes Mellitus 2018; 21(1): 5–14. doi: 10.14341/DM8781. (In Russ.)
  20. Mellon L., Brewer L., Hall P. et al. Cognitive impairment six months after ischaemic stroke: a profile from the ASPIRE-S study. BMC Neurol 2015; 15: 31. doi: 10.1186/s12883-015-0288-2. PMID: 25879880.
  21. Zaharov V.V., Vahnina N.V., Gromova D.O. et al. [Diagnostic and treatment of cognitive impairment after stroke]. Medicinskiy sovet 2015; (10): 14–20. doi: 10.21518/2079-701X-2015-10-14-21. (In Russ.)
  22. Tanashyan M.M., Konovalov R.N., Lagoda O.V. [New approaches to correction of cognitive disorders in cerebrovascular diseases]. Annals of clinical and experimental neurology 2018; 12(3): 30–39. doi: 10.25692/ACEN.2018.3.4. (In Russ.)
  23. Bogolepova A.N. [Cognitive impairment in patients with cerebrovascular disease]. Lechenie zabolevaniy nervnoy sistemy 2011; 3(3): 16–22. (In Russ.)
  24. Kulesh A.A., Shestakov V.V. [Vascular cognitive impairment, no dementia: diagnosis, prognosis, treatment, and prevention]. Nevrologiya, neiropsikhiatriya, psikhosomatika 2017; 9(3): 68–75. doi: 10.14412/2074-2711-2017-3-68-75. (In Russ.)
  25. Campbell N.L., Zhan J., Tu W. et al. Self-reported medication adherence barriers among ambulatory older adults with mild cognitive impairment. Pharmacotherapy 2016; 36: 196–202. doi: 10.1002/phar.1702. PMID: 26890914.
  26. Goldstein L.B., Bertels C., Davis J.N. Interrater reliability of the NIH stroke scale. Arch Neurol 1989; 46: 660–662. doi: 10.1001/archneur.1989.00520420080026. PMID: 2730378.
  27. Mahoney F., Barthel D. Functional evaluation: the Barthel lndex. Md State Med J 1965; 14: 61–65. PMID: 14258950.
  28. Nasreddine Z.S., Phillips N.A., Bédirian V. et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695–699. doi: 10.1111/j.1532-5415.2005.53221.x. PMID: 15817019.
  29. Dubois B., Slachevsky A., Litvan I., Pillon B. The FAB: a frontal assessment battery at bedside. Neurology 2000; 55: 1621–1626. doi: 10.1212/WNL.55.11.1621. PMID: 11502945.
  30. Hamilton M. The Hamilton rating scale for depression. Assessment of depression. Berlin, Heidelberg, 1986: 143–152. doi: 10.1007/978-3-642-70486-4_14.
  31. Morisky D.E., Green L.W., Levine D.M. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24: 67–74. PMID: 3945130.
  32. Zhuravskaya N.Yu., Kutishenko N.P., Martsevich S.Yu. et al. [Study of the physician recommendation adherence in patients after stroke. The role of anxiety and depression (registry LIS-2)]. Kardiovaskulyarnaya terapiya i profilaktika 2015; 14(2): 46–51. doi: 10.15829/1728-8800-2015-2-46-51. (In Russ.)
  33. Erkens J.A., Panneman M.M., Klungel O.H. et al. Differences in antihypertensive drug persistence associated with drug class and gender: a PHARMO study. Pharmacoepidemiol Drug Saf 2005; 14: 795–803. doi: 10.1002/pds.1156. PMID: 16178043.
  34. Hauptman P.J. Medication adherence in heart failure. Heart Fail Rev 2008; 13: 99–106. doi: 10.1007/s10741-007-9020-7. PMID: 17479364.
  35. Jankowska-Polańska B., Katarzyna L., Lidia A. et al. Cognitive function and adherence to anticoagulation treatment in patients with atrial fibrillation. J Geriatr Cardiol 2016; 13: 559. doi: 10.11909/j.issn.1671-5411.2016.07.006. PMID: 27605935.
  36. Hawkins L.A., Kilian S., Firek A. et al. Cognitive impairment and medication adherence in outpatients with heart failure. Heart Lung 2012; 41: 572–582. doi: 10.1016/j.hrtlng.2012.06.001. PMID: 22784869.
  37. Thiruchselvam T., Nagile G., Moineddin R. et al. Risk factors for medication nonadherence in older adults with cognitive impairment who live alone. Int J Geriatr Psychiatry 2012; 27:1275–1282. doi: 10.1002/gps.3778. PMID: 22337284.
  38. Semenova O.N., Naumova E.A. [Factors affecting on medication adherence: WHO parameters and the opinion of patients in the cardiology department]. Byulleten' meditsinskikh internet-konferentsiy 2013; 3(3): 507–511. (In Russ.)
  39. Hines R., Stone N.J. Patients and physicians beliefs and practices regarding adherence to cardiovascular medication. JAMA Cardiol 2016; 1: 470–473. doi: 10.1001/jamacardio.2016.0634. PMID: 27438324.
  40. Lukina Yu.V., Dmitrieva N.A., Kutishenko N.P. et al. [The relationship and interinfluence of aspects of therapy safety and compliance in patients with cardiovascular diseases (by the data from outpatient registry “PROFILE”)]. Kardiovaskulyarnaya terapiya i profilaktika 2018; 17(5): 72–78. doi: 10.15829/1728-8800-2018-5-72-78. (In Russ.)

Statistics

Views

Abstract: 1102

PDF (Russian): 729

Article Metrics

Metrics Loading ...

Dimensions

PlumX


Copyright (c) 2019 Bogolepova A.N., Kovalenko E.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies