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Key Barriers to Medication Adherence in Survivors of Strokes and Transient Ischemic Attacks

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ABSTRACT

BACKGROUND

Even though medications can greatly reduce the risk of recurrent stroke, medication adherence is suboptimal in stroke survivors.

OBJECTIVE

To identify key barriers to medication adherence in a predominantly low-income, minority group of stroke and transient ischemic attack (TIA) survivors.

DESIGN

Cross-sectional study.

PARTICIPANTS

Six hundred stroke or TIA survivors, age ≥ 40 years old, recruited from underserved communities in New York City.

MAIN MEASURES

Medication adherence was measured using the 8-item Morisky Medication Adherence Questionnaire. Potential barriers to adherence were assessed using validated instruments. Logistic regression was used to test which barriers were independently associated with adherence. Models were additionally controlled for age, race/ethnicity, income, and comorbidity.

KEY RESULTS

Forty percent of participants had poor self-reported medication adherence. In unadjusted analyses, compared to adherent participants, non-adherent participants had increased concerns about medications (26 % versus 7 %, p < 0.001), low trust in their personal doctor (42 % versus 29 %, p = 0.001), problems communicating with their doctor due to language (19 % versus 12 %, p = 0.02), perceived discrimination from the health system (42 % versus 22 %, p < 0.001), difficulty accessing health care (16 % versus 8 %, p = 0.002), and inadequate continuity of care (27 % versus 20 %, p = 0.05). In the fully adjusted model, only increased concerns about medications [OR 5.02 (95 % CI 2.76, 9.11); p < 0.001] and perceived discrimination [OR 1.85 (95 % CI 1.18, 2.90); p = 0.008] remained significant barriers.

CONCLUSIONS

Increased concerns about medications (related to worry, disruption, long-term effects, and medication dependence) and perceived discrimination were the most important barriers to medication adherence in this group. Interventions that reduce medication concerns have the greatest potential to improve medication adherence in low-income stroke/TIA survivors.

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Acknowledgements

We gratefully acknowledge the East and Central Harlem Community Action Board and the study participants for their generous contributions. Dr. Kronish received support from the National Heart, Lung and Blood Institute (K23 HL098359). Dr. Horowitz, Dr. Goldfinger and Ms. Fei received support from the National Institute of Minority Health and Health Disparities (P60MD00270), and Dr. Horowitz received funding from the National Center for Research Resources (UL1RR029887).

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA

    Ian M. Kronish MD, MPH & Donald E. Edmondson PhD

  2. Department of Urology, Mount Sinai School of Medicine, New York, NY, USA

    Michael A. Diefenbach PHD

  3. Department of Psychology, The George Washington University, Washington, DC, USA

    L. Alison Phillips PhD

  4. Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY, USA

    Kezhen Fei MS & Carol R. Horowitz MD, MPH

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  1. Ian M. Kronish MD, MPH
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Correspondence to Ian M. Kronish MD, MPH.

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Kronish, I.M., Diefenbach, M.A., Edmondson, D.E. et al. Key Barriers to Medication Adherence in Survivors of Strokes and Transient Ischemic Attacks. J GEN INTERN MED 28, 675–682 (2013). https://doi.org/10.1007/s11606-012-2308-x

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  • DOI: https://doi.org/10.1007/s11606-012-2308-x

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