The effect of a locally adapted, secondary stroke risk factor self-management program on medication adherence among veterans with stroke/TIA

Teresa Damush, Laura Myers, Jane A. Anderson, Zhangsheng Yu, Susan Ofner, Gloria Nicholas, Barbara Kimmel, Arlene A. Schmid, Thomas Kent, Linda Williams

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

We targeted stroke/transient ischemic attack (TIA) survivors to engage in self-management practices to manage secondary stroke risk factors. We conducted a randomized, regional pilot trial of a locally adapted, secondary stroke prevention program. We implemented the program at two Veterans Administration Medical Centers. Program sessions targeted stroke risk factor self-management. Specifically, we evaluated the effect of the program on the reach, implementation, and effectiveness on patient self-efficacy; stroke-specific, health-related quality of life; and medication adherence for the prevalent stroke risk factors: (1) diabetes, (2) hypertension, and (3) hyperlipidemia. Medication possession ratios were calculated to evaluate medication adherence using VA pharmacy benefits data pre (6 months prior) and post (6 months after) the stroke/TIA event. Based upon the literature standard of 80 % compliance rate, we dichotomized compliance and modeled the data using logistical regression. Final sample included 174 veterans with an acute stroke or TIA who were randomized to receive either the intervention (n = 87) or attention control program (n = 87). Patient self-efficacy and stroke-specific, health-related quality of life at 6 months did not significantly differ between groups. We found improvements in medication adherence within the intervention group. In the intervention group, the odds of compliance with diabetes medications post-stroke were significantly larger than the odds of compliance prior to the stroke (odds ratio = 3.45 (95 % CI = 1.08–10.96). For compliance to hypertension medications, the intervention group showed significantly greater odds of compliance post intervention than pre intervention (odds ratio = 3. 68 (95 % CI = 1.81–7.48). The control group showed no difference in compliance rates from baseline to follow-up. For adherence to hypercholesterolemia medications, both the intervention (odds ratio = 5.98 (95 % CI = 2.81–12.76) and control groups (odds ratio = 3.83 (95 % CI = 1.83–8.01), had significant increases in the odds of compliance to statin medications; however, the comparison of changes in log odds of compliance between these two groups showed that the increases were not significantly different. We observed within group improvements in medication adherence among those receiving a post-stroke risk factor self-management program suggesting that a self-management format may be feasible to enable adherence to prescribed medications to reduce secondary stroke risk after stroke in concordance with guideline care. Additional research is needed to enhance intervention components to improve effectiveness outcomes.

Original languageEnglish (US)
Pages (from-to)457-468
Number of pages12
JournalTranslational Behavioral Medicine
Volume6
Issue number3
DOIs
StatePublished - Sep 1 2016

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Medication Adherence
Transient Ischemic Attack
Veterans
Self Care
Stroke
Compliance
Odds Ratio
Self Efficacy
Quality of Life
Hypertension
Hydroxymethylglutaryl-CoA Reductase Inhibitors
United States Department of Veterans Affairs
Control Groups
Secondary Prevention
Hypercholesterolemia
Hyperlipidemias
Type 2 Diabetes Mellitus
Survivors

Keywords

  • Local adaptation
  • Medication adherence
  • Secondary stroke prevention

ASJC Scopus subject areas

  • Behavioral Neuroscience
  • Applied Psychology

Cite this

The effect of a locally adapted, secondary stroke risk factor self-management program on medication adherence among veterans with stroke/TIA. / Damush, Teresa; Myers, Laura; Anderson, Jane A.; Yu, Zhangsheng; Ofner, Susan; Nicholas, Gloria; Kimmel, Barbara; Schmid, Arlene A.; Kent, Thomas; Williams, Linda.

In: Translational Behavioral Medicine, Vol. 6, No. 3, 01.09.2016, p. 457-468.

Research output: Contribution to journalArticle

Damush, Teresa ; Myers, Laura ; Anderson, Jane A. ; Yu, Zhangsheng ; Ofner, Susan ; Nicholas, Gloria ; Kimmel, Barbara ; Schmid, Arlene A. ; Kent, Thomas ; Williams, Linda. / The effect of a locally adapted, secondary stroke risk factor self-management program on medication adherence among veterans with stroke/TIA. In: Translational Behavioral Medicine. 2016 ; Vol. 6, No. 3. pp. 457-468.
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