Evaluating the support stroke survivors get with daily medication taking in the community: interim results of a primary care survey.

Problem

Around half of stroke survivors are dependent on others for everyday activities. However, the percentage of community stroke survivors relying on caregivers for some or all aspects of medicine taking is not known, nor how many have unmet needs. Studies on adherence to secondary prevention after stroke have mainly concentrated on patients who are responsible for their own medicine taking. Research in the field suggests that having a caregiver is associated with better adherence to medication We currently know little about the factors that influence adherence in stroke survivors with disabilities who are still living in the community (i.e. not in nursing homes) and the role of their caregivers in patient’s adherence to medication.

The aim of this study is to evaluate the support stroke survivors get with taking their medication in the community and to understand the extent to which caregivers play a role in providing support.

Approach

A postal survey of GP practices in East of England and London.

The survey was developed through three workshops with a total of 26 stroke survivors and 12 caregivers in the East of England. Nearly half of all patients reported needing help with daily medicines. We identified 5 main domains of support needed with medicine taking which informed the survey: getting medicines home; getting medicines out of the box; prompting ‘It’s time to take your medicine’; swallowing medicines; checking whether medicines have been taken.

A questionnaire was sent to 1,132 stroke survivors and caregivers from 11 practices, between September and December 2016. Caregivers (family members, friends or paid caregivers) were recruited though stroke survivors, provided they were felt as helping with stroke survivors’ medicine taking. When appropriate, caregivers then completed their own copy of the survey.

Findings

Stroke survivors’ mean age was 75 years (SD 12.6, n=387), 61% were male, 8 years post stroke (SD 7), on 6.3 daily medications (SD 3.6), mean Barthel score of 16.4 (SD 3.8). 32.5% of patients needed help with daily medication taking. Help consisted of dealing with prescriptions (often/all-the-time in 33%), reminding medicine times (16%), getting medicines out of blisters/boxes (15.5%), checking whether tablets were taken (15.5%) and assisting with swallowing medicines (10%). About 1 in 20 participants felt they needed more help with reminding times to take medicines and getting the medicine out of blisters pack and boxes.

Consequences

Interim results provided insight into knowledge, role and burden of medicine taking after stroke. A third of patients with stroke in the community need help with daily medication taking and a significant percentage have unmet needs. Results raise healthcare professionals’ awareness of stroke survivors’ needs and caregivers’ roles in relation to daily medication routines in the community and inform the development of future interventions to improve adherence.