Status Analysis Of Medication Compliance In Secondary Prevention For Ischemic Stroke:A Mixed-method Study

Objectives:To explore the current status and related factors of medication adherence in secondary prevention for ischemic stroke(IS).Methods:A mixed-method research was applied.Part I:In the survey,from September 2018 to January 2019,204 patients with acute ischemic stroke were obtained after discharge from neurology department in the Guangdong provincial hospital of Chinese medicine.Data collection included the patients’ demographics,clinical characteristics,medications use in secondary prevention,Morisky Medication Adherence Scale-4(MMAS-4),and stroke self-efficacy questionnaire(SSEQ).According to the medication adherence,patients were divided into compliance and noncompliance groups.A multi-variable logistic regression was used to explore the factors associated with adherence after discharge.Part II:In the qualitative study,a semi-structured interview was conducted among the convenience sample of 10 ischemic stroke survivors,7neurology physicians and 4 nurses.Results:(1)The rate of medications compliance in anti-platelet drugs,anticoagulant drugs,statins,anti-hypertensive drugs and diabetes drugs were 53.57%,71.42%,61.08%,66.18%and 52.93%,respectively.(2)Multivariate logistic regression analysis suggested that antithrom-botics adherence was significantly associated with education(P<0.01),stroke duration(P<0.05),drugs types(P<0.01),drugs frequency(P<0.05),SSEQ(P<0.05),self-perception on care demand(P<0.01),TOAST classification(P<0.01).(3)Multivariate logistic regression analysis suggested that statins adherence was significantly associated with drugs types(P<0.01),diabetes drugs use(P<0.01),SSEQ(P<0.01),mRS≥3(P<0.01).(4)By Colaizzi phenomenological analysis method,2 themes on the medication compliance were summarized:patients with higher health literacy and family support held better medication compliance in stroke secondary prevention.Those with poor stroke knowledge,poor income,more drugs per day,occurring adverse reactions,poor social support and negative mood were more likely with noncompliance medication in stroke secondary prevention.Conclusion:The compliance of secondary prevention medications was poor in Chinese patients with IS.Low SSEQ,poor education,mRS≥3,poor social support,more drugs types and frequencies,and drugs adverse reactions were predictors of medications noncompliance.