Healthcare professional perspectives on medication challenges in the post-stroke patient

Abstract

Background: Medications play an essential role in the management of patients who have experienced a stroke. Despite the recognised importance and widespread availability of secondary prevention guidelines, Irish research has shown a continuous failure to meet secondary prevention targets upon discharge. While complex interventions involving healthcare professionals (HCPs) such as Speech and Language Therapists (SLT), Occupational Therapists (OTs) and Pharmacists have been effective in combatting medication non-adherence, community multidisciplinary teams (MDTs) are not as well defined as in the acute setting, leading to wide variation in patient care. Therefore, this study aims to investigate the knowledge, attitudes, beliefs, and challenges faced by HCPs in the continuity of care post-discharge from a hospital stroke ward, and its impact on medication adherence.Methods: Semi-structured interviews and one focus group with HCPs were conducted, and data were analysed using Braun & Clarke’s reflexive Thematic Analysis.Results: Fourteen HCPs (6 Pharmacy, 4 SLT, 4 OTs) participated in this study. Participants discussed their views under two main themes 1) continuity of care and 2) medication adherence. Sub-themes observed regarding continuity of care include management and organisation, interpersonal continuity, and informational continuity. Themes generated which impact medication adherence post-discharge include condition-related factors, medication-related factors, systemic and HCP factors, and patient-related factors.Discussion: Additional resources are required to bring community healthcare in line with the standard of acute care. Increased channels of communication must be established across contexts and disciplines, and may be achieved using interprofessional training through continuous professional development or third-level education, a more clearly defined community team structure, and discharge summaries completed to relevant quality standards. While suboptimal continuity of care was reported as contributing to medication non-adherence, HCPs also acknowledged the complexities of medication management post-stroke.

Emerging Post-Hospital Models of Care: A Primer for Stroke Center Leaders

“…2 Because the acute stroke admission is often short, stroke survivors may lack continuity of care related to medication management and clinical management of stroke risk factors. 5 Historically, inpatient certified stroke programs were expected to prepare patients with stroke for discharge, educate the patient and family, and provide some preliminary anticipatory care. 6 However inpatient stroke programs often failed to take an active role in the coordination or provision of care postdischarge.…”