Improving Adherence to Medication in Stroke Survivors: A Pilot Randomised Controlled Trial

O’Carroll, Ronan E.; Chambers, Julie A.; Dennis, Martin; Sudlow, Cathie; Johnston, Marie

doi:10.1007/s12160-013-9515-5

Cited by 110 publications

(118 citation statements)

References 29 publications

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“…Results on the main outcome measure are fully reported in the simple effects article (O'Carroll et al, 2013). In brief, the Intervention group had higher overall adherence than the Control group on all MEMS measures (percentage of total doses taken: Intervention group mean 99% versus Control 94%, 95% CI for difference (-1.6, 9.0); percentage of days correct dose taken: Intervention group mean 99% versus Control 93%, 95% C.I.…”

Section: Primary Outcome Measure -Mems Electronic Pill Bottlementioning

confidence: 99%

Improving medication adherence in stroke survivors: Mediators and moderators of treatment effects.

O’Carroll¹,

Chambers²,

Dennis³

et al. 2014

Health Psychology

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Objective: The purpose of the current study was to test theory-based predictions of mediators and moderators of treatment effects of a pilot randomised controlled trial which aimed to increase adherence to preventive medication in stroke survivors via addressing both automatic (i.e. habitual responses) and reflective (i.e. beliefs and value systems) aspects of medication-taking behaviour.Methods: Sixty-two stroke survivors were randomly allocated to either an Intervention or Control group. Intervention participants received a brief two-session intervention aimed at increasing adherence via a) helping patients establish better medication-taking routines using implementation intentions plans (automatic) and b) eliciting and modifying any mistaken patient beliefs regarding medication and/or stroke (reflective). The Control group received similar levels of non-medication-related contact. Primary outcome was adherence to antihypertensive medicine measured objectively over 3 months using an electronic pill bottle.Secondary outcome measures included self-reported adherence (including forgetting) and beliefs about medication. Results:Intervention participants had 10% greater adherence on doses taken on schedule (intervention 97%; control 87%, 95% CI (0.2, 16.2), p = .048), as well as significantly greater increases in self-reported adherence and reductions in concerns about medication. Treatment effects were mediated by reductions in both forgetting and concerns about medication; and moderated by the presence of pre-existing medication-taking routines. Conclusions:Addressing both automatic and reflective aspects of behaviour via helping stroke survivors develop planned regular routines for medication-taking and addressing any concerns or misconceptions about their medication can improve adherence and thus potentially patient outcomes.3

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Section: Primary Outcome Measure -Mems Electronic Pill Bottlementioning

confidence: 99%

Improving medication adherence in stroke survivors: Mediators and moderators of treatment effects.

O’Carroll¹,

Chambers²,

Dennis³

et al. 2014

Health Psychology

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“…Of these, 18 articles concerned 15 studies with a patient population and stated that an implementation intention had been used [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66]. Two articles were excluded as they described the development of an intervention, an RCT protocol and its feasibility testing [63,64].…”

Section: Resultsmentioning

confidence: 99%

“…The four included studies (reported in five articles) concerned the evaluation of the effectiveness of an if-then plan on i) medication adherence in epilepsy [51] and stroke [53,65], ii) improving exercising and behavioural change in people with chronic back [60], and iii) improving physical activity in obese older adults [66]. Table 2 outlines a summary of the interventions employed in the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…44.1 (16.4), 38% male  14-Page packet of self-report measures at baseline Intervention group: n=37, mean (SD) age 41.9 (15.4), 42% male  14-Page packet of self-report measures at baseline, plus:  Self-completed intention implementation worksheet: writing down environmental cues for tablet taking using the format of an "if-then" plan on the worksheet, repeating this plan 3 times quietly, when able repeat it without reading tick a box. [51,53,60,65,66]; and data on key outcomes being available at follow-up for fewer than 85% of participants allocated to the groups [51,60,66]. Further limitations of the included studies will be discussed below.…”

Section: Resultsmentioning

confidence: 99%

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Bridging the gap between goal intentions and actions: a systematic review in patient populations

Kersten¹,

McCambridge²,

Kayes³

et al. 2014

Disability and Rehabilitation

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Purpose: To evaluate the evidence for the effectiveness of if-then implementation intentions (if-then plans) in adult patient populations. Outcomes of interest included adherence, goal pursuit and physical health outcomes.Method: Keywords were used to search electronic databases without date or language restrictions (up to 30/4/14). Studies were included if they 1) concerned a patient population; 2) used if-then plans as a sole intervention or as part of treatment, therapy or rehabilitation; 3) if they were randomised controlled trials. The PEDro scale was used to evaluate study quality. Guidance as set out by the Cochrane Collaboration was used. Two reviewers independently extracted data, discrepancies were discussed and if required referred to a third reviewer.Results: 18 of 2,141 articles were identified as potentially relevant and four studies of people with epilepsy, chronic back pain, stroke and obesity met the inclusion criteria. People who form if-then plans achieved better outcomes on epilepsy and stroke medication adherence and physical capacity than controls. Conclusions:Of the four studies that used an if-then plan only one, with people with epilepsy, looked at the intervention as a stand-alone strategy. Further research needs to explore if this simple approach improves rehabilitation outcomes and is a helpful and feasible strategy for people experiencing disabilities.

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“…Only one study investigated impact of physician-led counselling following first stroke/transient ischaemic attack (TIA). This UK RCT included 62 individuals, with high risk of bias overall 21 (table 3). At 3 months, adherence to antihypertensive medication was higher in the intervention group for doses taken on schedule (ie, mean difference, 9.8%; 95% CI (0.2 to 16.2); p=0.048).…”

Section: Patient Counsellingmentioning

confidence: 99%

Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: A systematic review

Werba

Khandelwal

Nambiar

et al. 2017

Nutrition, Metabolism and Cardiovascular Diseases

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Background: Secondary prevention is cost-effective for cardiovascular disease (CVD), but uptake is suboptimal. Understanding barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy.Objectives: To conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level.Methods: Included studies reported effects of health system level factors on adherence/persistence to secondary prevention medications for CVD (coronary artery or cerebrovascular disease). Studies considered at least one of β blockers, statins, angiotensin-renin system blockers and aspirin. Relevant databases were searched from 1 January 1966 until 1 October 2015. Full texts were screened for inclusion by 2 independent reviewers.

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Improving Adherence to Medication in Stroke Survivors: A Pilot Randomised Controlled Trial

Abstract: A simple, brief intervention increased medication adherence in stroke survivors, over and above any effect of increased patient contact or mere measurement.

Cited by 110 publications

References 29 publications

Improving medication adherence in stroke survivors: Mediators and moderators of treatment effects.

Improving medication adherence in stroke survivors: Mediators and moderators of treatment effects.

Bridging the gap between goal intentions and actions: a systematic review in patient populations

Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: A systematic review

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