Optimisation of secondary prevention of stroke: a qualitative study of stroke patients’ beliefs, concerns and difficulties with their medicines†

Abstract

Many of the difficulties stroke patients have adhering to secondary prevention strategies are potentially preventable with tailored information provision and appropriate monitoring and follow-up by primary healthcare professionals. We have designed an intervention addressing the identified barriers to medicine taking, the impact of which is currently being measured in a randomised controlled trial of a pharmacist-led home-based clinical medication review in stroke patients.

GPs’ perspectives on secondary cardiovascular prevention in older age: a focus group study in the Netherlands

“…11,17 Also, patient factors, such as vulnerability, 18 the presence of comorbidities, 19 drug interactions, and/or side-effects, 20 may lead doctors to decide not to treat older patients. In addition, older patients themselves may fail to attend followup consultations, or stop taking medication because of illness perceptions 21,22 or sideeffects. Besides these individual factors, the organisation of health care also may influence treatment uptake.…”

A pilot study to assess the practicality, acceptability and feasibility of a randomised controlled trial to evaluate the impact of a pharmacist complex intervention on patients with stroke in their own homes

“…Randomisation to intervention or usual care group was undertaken using sequentially numbered opaque envelopes prepared by an independent person to ensure allocation concealment. Previous work suggests patients living alone have more problems with their medicines 3. Therefore, stratification was applied prior to randomisation to ensure equal numbers of living alone in each group.…”

“…In the acute setting, this usually includes a specialist clinical pharmacist, while, on discharge from hospital, pharmaceutical care is generally managed by non-specialist community pharmacists. A proportion of patients with stroke on discharge do not have contact with the community pharmacist because they are unable to visit the pharmacy in person 3 4. Qualitative studies in homes of patients with stroke have identified the barriers and difficulties which patients experience when taking their medicines 3 4.…”

“…A proportion of patients with stroke on discharge do not have contact with the community pharmacist because they are unable to visit the pharmacy in person 3 4. Qualitative studies in homes of patients with stroke have identified the barriers and difficulties which patients experience when taking their medicines 3 4. Stable medicine routines, appropriate medicine and illness beliefs, communication at the secondary/primary care interface, individualised information and practical help from healthcare staff about managing medicines are the key factors in optimising medicine-taking behaviour 3 4…”

“…Systematic reviews have concluded that few complex interventions in stroke have been ‘adequately developed or evaluated’ due to multiple primary outcomes, insufficient statistical powering and poor intervention development 12 13. Our complex intervention is based on previous pharmaceutical needs assessment 3. We propose to undertake a randomised controlled trial (RCT) to evaluate a complex intervention14 of structured pharmaceutical care (see online supplementary appendix 1) delivered by a pharmacist to patients with stroke in their own homes with the hypothesis that the intervention will increase the proportion of patients reaching target BP.…”