Over a half of stroke patients require a degree of help with taking medicine and a sizeable minority say they do not receive as much assistance as they need, according a study published today in the journal BMJ Open.
Because of the risk of a second stroke, it’s important that stroke survivors take their medication, but our study has shown that this can present challenges
Anna De Simoni, visiting researcher, Primary Care Unit
According to the Stroke Associations, as many as four in ten people who have had a stroke, go on to have another one within ten years. As a second stroke carries a greater risk of disability and death than first time strokes, it is important that survivors take medicine daily to lower their risk. There are around 1.2 million stroke survivors in the UK, and at least a third suffer from severe impairments, potentially making adherence to their medicine difficult.
Half of survivors of stroke are dependent on others for everyday activities, though the proportion dependent on others for medicine taking or needing more practical help with tablets is not known.
To examine the practical support stroke survivors living in the community need and receive with taking their medicines, researchers at the University of Cambridge and Queen Mary University of London carried out a postal questionnaire study. The researchers developed the questionnaire together with stroke survivors and caregivers. The questionnaire was completed by 600 participants across 18 GP practices in the UK.
More than half (56%) of respondents needed help with taking medication. This included help with prescriptions and collection of medicines (50%), getting medicines out of the packaging (28%), being reminded to take medicines (36%), swallowing medicines (20%) and checking that medicines have been taken (34%). Being dependent on others was linked to experiencing more unmet needs with daily medicine taking.
Around one in ten (11%) of respondents answered yes to the question “Do you feel you need more help?” The most commonly reported areas where respondents said they needed more assistance were being reminded to take medicines, dealing with prescriptions and collection of medicines, and getting medicines out the packaging. As a result, around one in three (35%) of respondents said they had missed taking medicine in the previous 30 days.
Stroke survivors taking a higher number of daily medicines and experiencing a greater number unmet needs with practical aspects of medicine-taking were more likely to miss medications.
Interestingly, the researchers found that younger stroke survivors were more likely to miss their medicines, possibly because they are less likely to receive help from a caregiver.
“Because of the risk of a second stroke, it’s important that stroke survivors take their medication, but our study has shown that this can present challenges,” says Dr Anna De Simoni from the Primary Care Unit at the University of Cambridge and Queen Mary University of London. “In the majority of cases, they receive the help they need, but there is still a sizeable minority who don’t receive all the assistance they need.”
James Jamison, also at the Primary Care Unit, University of Cambridge, who led the study as part of his PhD, adds: “Our study has shown us some of the barriers that people face to taking their medication regularly. We also learned that stroke survivors who are dependent on others are most likely to need more assistance than they currently receive.
“Our response rate was relatively low – just over one in three – so we need more research to find out if what we’ve heard from our respondents is widespread among stroke survivors. If so, this will have implications for the care provided.”
The team point to the need to develop new interventions focused on the practicalities of taking medicines and aimed at improving stroke survivors’ adherence to treatment. “Advances in technology have the potential to help improve adherence, such as electronic devices prompting medication taking times,” says Jamison. “Efforts to improve medication taking among survivors of stroke using technology are already underway and have shown promise.”
The research was supported by the Royal College of General Practitioners, National Institute for Health Research (NIHR), the Stroke Association and the British Heart Foundation.
Jamison J, Ayerbe L, Di Tanna GL, Sutton S, Mant J, De Simoni A. Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: A survey. 2018 BMJ Open. DOI: 10.1136/bmjopen-2017-019874
James’ research seeks to understand why people sometimes do not take the medications prescribed by their GP – and then to use this to inform interventions aimed at improving their medication taking practices.
His day-to-day activities are very varied, he says. “They can involve anything from the development of research proposals, liaising with GP practices and pharmacies in the East of England to set up research studies, training health care professionals in research procedures, conducting interviews with patients, collecting questionnaire data or writing up research for publications in health care journals.”
However, the most rewarding and interesting part is coming face-to-face with stroke survivors and their caregivers to talk about their condition and the daily challenges they face, he adds.
“Working at Cambridge provides the opportunity to be part of a leading department conducting research in primary care and offers the potential to work with esteemed colleagues in the field,” he says. “The opportunity to deliver high quality research outputs and undertake collaborations will hopefully help further my career as a successful health care researcher.”