Impact of Introducing the Pletaal Assist System on Drug Adherence in Outpatients with Ischaemic Stroke: A Pilot Study

Abstract

The effectiveness of Electronic Medication Packaging devices for monitoring drug adherence has been widely reported. However, conventional devices are expensive for routine use and cannot confirm whether the medication was administered. We aimed to determine, in a pilot and feasibility study, the impact of introducing a new medication support device, the Pletaal Assist System ® , to monitor and improve cilostazol adherence for stroke prevention at an outpatient clinic. Patients and Methods: We assessed consecutive patients treated with cilostazol for >3 months at our stroke outpatient clinic from January 2018 to March 2020. The adherence rate was assessed as follows: (the number of pills prescribed minus the number of remaining pills)/the number of pills prescribed. We compared the adherence rates before, during, and after Pletaal Assist System ® usage, respectively. Results: Overall, 25 patients (median age, 68.5 years; range, 51-86 years; male, 64%) were enrolled. All participants were prescribed cilostazol (100 mg) twice a day. There was no significant difference in the adherence rate among the three periods. However, in 10 patients with adherence rate below 100%, the adherence rate during Pletaal Assist System ® usage was higher than before usage (99.5% vs 95%, p=0.04), and the rate after using the Pletaal Assist System ® tended to be lower compared to the rate during usage (99.5% vs 96%, p=0.05). Conclusion:Our preliminary evidence suggest that the Pletaal Assist System ® could further improve cilostazol adherence in outpatients with poor drug adherence and may reduce the risk of recurrent strokes by improving adherence of patients with a history of stroke.

Medication self-management interventions for persons with stroke: A scoping review

“…The most common quantitative study designs included randomized controlled trials (n = 31) and prospective studies (n = 11). Most articles (n = 53) were published after 2010 [ 34 – 61 , 63 – 66 , 68 – 70 , 72 – 89 ], with only three being published prior [ 62 , 67 , 71 ]. Studies were conducted across 20 different countries, with the majority conducted in the United States (n = 14) [ 38 , 42 – 45 , 50 , 57 , 59 , 67 , 74 , 81 – 83 , 88 ] and China (n = 11) [ 40 , 46 , 73 , 76 – 80 , 84 – 86 ].…”

“…Studies were conducted across 20 different countries, with the majority conducted in the United States (n = 14) [ 38 , 42 – 45 , 50 , 57 , 59 , 67 , 74 , 81 – 83 , 88 ] and China (n = 11) [ 40 , 46 , 73 , 76 – 80 , 84 – 86 ]. Other countries included the United Kingdom (n = 4) [ 63 , 64 , 69 , 72 ], South Korea (n = 2) [ 55 , 56 ], Australia (n = 2) [ 41 , 65 ], Belgium (n = 2) [ 54 , 75 ], Germany (n = 2) [ 49 , 60 ], Ghana (n = 2) [ 68 , 89 ], Hong Kong (n = 2) [ 70 , 71 ], India (n = 2) [ 34 , 39 ], Malaysia (n = 2) [ 35 , 87 ], New Zealand (n = 2) [ 36 , 61 ], Pakistan (n = 2) [ 52 , 53 ], Austria (n = 1) [ 47 ], Denmark (n = 1) [ 48 ], France (n = 1) [ 37 ], Israel (n = 1) [ 62 ], Japan (n = 1) [ 66 ], Thailand (n = 1) [ 58 ], and Turkey (n = 1) [ 51 ].…”

“…The sample sizes varied, ranging from 2 participants to 5,882 participants (median = 174; IQR = 202). The majority of articles reported the sex (n = 32) [ 34 , 38 , 41 , 43 – 49 , 52 , 53 , 56 , 57 , 59 , 61 , 65 , 66 , 68 – 74 , 77 – 79 , 84 – 86 , 88 ] or gender (n = 19) [ 35 , 37 , 39 , 40 , 42 , 51 , 54 , 55 , 58 , 60 , 62 , 63 , 75 , 76 , 80 – 83 , 87 ] of participants, but no articles reported both sex and gender. Level of education was reported by 29 articles [ 35 , 36 , 39 , 42 , 45 , 47 , 50 – 53 , 55 , 58 , 59 , 62 , 68 , 70 , 71 , 73...…”

“…Income level (n = 12) [ 45 , 46 , 51 , 52 , 55 , 58 , 59 , 62 , 68 , 73 , 76 , 81 ] and household composition (n = 10) [ 36 , 39 , 41 , 42 , 51 , 52 , 61 , 62 , 71 , 72 ] were reported less frequently, in about one fifth of included articles. Comorbidities experienced by participants were reported in 27 articles [ 35 , 37 , 39 , 41 , 45 , 47 , 48 , 51 , 52 , 54 , 56 – 60 , 62 , 66 , 68 – 70 , 73 , 76 – 78 , 84 , 87 , 88 ], with hypertension, diabetes, and dyslipidemia being the most commonly reported.…”

“…The goals of the interventions were largely similar across the included studies and focused on: secondary stroke prevention through risk factor management and lifestyle modifications, improving medication-related knowledge, self-efficacy, medication adherence, and quality of life, increasing knowledge of stroke (signs, symptoms, management, risk factors), and improving care coordination and transitions. A component of medication self-management was the primary focus in 13 studies [ 39 , 49 , 52 , 62 – 64 , 66 , 67 , 72 , 73 , 78 , 81 , 86 ], with the majority (n = 43) including it as a part of a larger intervention or as an outcome measure. Two-thirds of the interventions consisted of multiple components (n = 42) [ 34 , 35 , 38 – 48 , 51 – 54 , 56 – 60 , 62 – 65 , 67 – 74 , 77 , 79 , 82 – 85 , 87 , 88 ], while the other third were stand-alone interventions (n = 14) [ 36 , 37 , 49 , 50 , 55 , 61 , 66 , 75 , 76 , 78 , 80 , 81 , 86 , 89 ].…”