Medication adherence poor among Singaporean stroke patients
Patients with ischaemic stroke or transient ischaemic attack in Singapore appear to adhere poorly to their medication schedule, according to a cross-sectional, descriptive study.
“Th[e] study may provide useful pointers for health professionals to understand the status of medication adherence in Singaporean stroke patients and its independent predictors,” the authors said. “[It] will also help … identify patients who are likely to have greater risk of poor medication adherence, so that a tailored intervention can be provided to enhance their adherence.”
The authors evaluated adherence to treatment in a cohort of 121 stroke patients at least 21 years of age from a local tertiary hospital using the Morisky Medication Adherence Scale-8 (MMAS-8). The mean MMAS-8 score was 5.07, with only 18.2 percent of patients having high adherence levels and majority (53.7 percent) having low. [J Clin Nurs 2017;doi:10.1111/jocn.14001]
Multivariate linear regression analysis identified two important predictors of MMAS-8-assessed medication adherence, namely ‘understanding the benefits of medications’ (p=0.010) and ‘having suffered from stroke twice or more’ (p=0.014). These two factors accounted for 12.4 percent of the variance.
Specifically, the higher number of strokes a patient had had, the better his adherence to medication. This finding is “novel and could be explained by the fact that patients experience more severe signs and symptoms if they suffered from stroke recurrence, which could result in increasing their awareness of and attention to taking medication to relieve symptoms and prevent recurrence,” the authors said.
On the other hand, the role of ‘understanding the benefits of the medication’ in predicting adherence is said to be supported by previous studies arguing that the beliefs of individuals about the benefits of treatment will motivate them to follow the therapy and adhere to their medication schedule. [Pharmacoepidemiol Drug Saf 2009;18:672-681; Ann Behav Med 2011;41:383-390; PLoS One 2013;8:e80633; BMJ Open 2013;3:e003551]
There is a belief in the Asian culture that all medication contains a toxic element, and the authors pointed out that with such a belief, patients tend to be blind to the benefits of their medication as a result of being more concerned about the side-effects. [Int J Stroke 2014;9(Suppl 4):7; BMC Endocr Disord 2016;16:1]
While the study might be limited by participant recruitment on the basis of convenience sampling from a single hospital, its findings clearly highlight the need to provide appropriate explanations of the medications’ purposes and benefits to reinforce positive beliefs in medications, the authors said.
“Helping patients understand the long-term benefits of their medications will result in better medication adherence and prevention of stroke recurrences. The education information should be [delivered] in a clear, direct and thorough manner,” they added.