Why Stroke Patients Disobey Orders

When survivors, care providers and other healthcare professionals collaborate they should be able to stop many secondary strokes in patients, a study found.

The challenge is to get these patients to take appropriate medications as prescribed.

The research, conducted by James Jamison of the Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, and colleagues, and was published in the British Journal of General Practice in May, 2016.

The researchers undertook this interview study in order to identify barriers to medication adherence among stroke survivors, which is well-known to be suboptimal. They interviewed 28 stroke survivors, 14 caregivers, and 5 general practitioners.

Through the 33 interviews the researchers identified two basic categories of barriers, those they describe as patient level and those they call medication level.

At the patient level, barriers included the ability to care for themselves, how seriously patients take the stroke, and the level of knowledge about stroke and medication.

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At the medication level, barriers included patients' beliefs about medication,

For instance, one patient interviewed said, "I think aspirins are good for you . . .I just don't see why I'm taking other medication, I'm not fat or anything like that."

The study also found issues involving taking secondary prevention medication, the routines surrounding the taking of medication, problems with changing medications, and the levels of difficulty and burden of treatment.

This study confirms some previously suspected barriers, and adds to the growing body of research that delves into barriers to adhering to a medication regimen. Additionally, the present study highlights “the important role of the caregiver in providing information and facilitating medication-taking behavior” according to the authors.

More research into how the barriers identified in this study relate to day-to-day adherence could help develop effective interventions.

The researchers say, “These findings provide an important basis from where effective adherence interventions to improve stroke care may be developed and implemented in clinical practice.” They further advocate for a collaborative approach in which the role of the caregiver is given significant attention, and one in which communication among all parties is enhanced.