Abstract TP415: Implementation of a Secondary Stroke Prevention Program: Effect on Medication Adherence
We targeted both providers and patients for medication and lifestyle modification to reduce secondary stroke risk factors after stroke.
The specific aim of this study was to:
Conduct a quasi-experimental feasibility test of implementing the adapted VA stroke prevention program (VSPP) at two VA sites to evaluate the impact on medication adherence.
Program sessions targeted stroke risk factor management. The key stroke risk factors of interest were: 1) hypertension, 2) diabetes, 3) hypercholesterolemia. Medication possession ratios based upon patient medication refills were calculated to evaluate medication compliance for the randomized subjects using PBM data pre (6 months prior to the acute event) and post (6 months after the event). Based upon the literature standard of 80% compliance, we used this rate to dichotomize and model the data using logistics regression.
Results: The final sample included 174 veteran patients with an acute stroke/TIA who were randomized to receive either the intervention (n=87) or a control program (n=87). In the intervention group, the odds of compliance to diabetes meds post stroke were significantly larger than the odds of compliance prior to the stroke (odds ratio=3.45 (1.08, 10.96) p <0.04). The control group saw a decrease in the likelihood of compliance from pre to post stroke hospitalization (odds ratio =0.51 (0.10, 2.70), p<.42). The comparison between groups was marginally significant (odds ratio=6.74 (0.88, 51.31), p=0.06) which indicates an intervention effect on compliance of DM drug. Both the intervention and control groups had significant increases in the odds of compliance to statin medications; however, there were no significant difference between groups. For compliance to hypertension medications, the intervention group showed significantly greater odds of compliance post intervention than pre intervention (odds ratio=3.68 (1.81, 7.48), p<.0004) but no difference in the control group. We observed over a threefold increase in diabetes medication compliance among stroke survivors who were diabetic and assigned to the intervention group and we observed a significant decrease in diabetic medication compliance among those assigned to the control group. Funded by VHA HSRD IAB 05-297-2
- © 2012 by American Heart Association, Inc.