Barriers to medication adherence for the secondary prevention of stroke: a qualitative interview study in primary care

James Jamison, Jonathan Graffy, Ricky Mullis, Jonathan Mant, Stephen Sutton
British Journal of General Practice: the Journal of the Royal College of General Practitioners 2016, 66 (649): e568-76

BACKGROUND: Medications are highly effective at reducing risk of recurrent stroke, but success is influenced by adherence to treatment. Among survivors of stroke and transient ischaemic attack (TIA), adherence to medication is known to be suboptimal.

AIM: To identify and report barriers to medication adherence for the secondary prevention of stroke/TIA.

DESIGN AND SETTING: A qualitative interview study was conducted within general practice surgeries in the East of England, UK.

METHOD: Patients were approached by letter and invited to take part in a qualitative research study. Semi-structured interviews were undertaken with survivors of stroke, caregivers, and GPs to explore their perspectives and views around secondary prevention and perceived barriers to medication adherence. Key themes were identified using a grounded theory approach. Verbatim quotes describing the themes are presented here.

RESULTS: In total, 28 survivors of stroke, including 14 accompanying caregivers and five GPs, were interviewed. Two key themes were identified. Patient level barriers included ability to self-care, the importance people attach to a stroke event, and knowledge of stroke and medication. Medication level barriers included beliefs about medication and beliefs about how pills work, medication routines, changing medications, and regimen complexity and burden of treatment.

CONCLUSION: Patients who have had a stroke are faced with multiple barriers to taking secondary prevention medications in UK general practice. This research suggests that a collaborative approach between caregivers, survivors, and healthcare professionals is needed to address these barriers and facilitate medication-taking behaviour.

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