Medications adherence and associated factors among patients with stroke in the Kingdom of Saudi Arabia
Main Article Content
Stoke, Adherence, Self-care activities, KSA
Background: Stroke is one of the most significant neurological problems around the world, and is considered a leading cause of death. Due to polypharmacy and multimorbidity, stroke patients are susceptible to have lower levels of adherence to their medications and self-care activities. Methods: Patients who have suffered a stroke and had recently been admitted to public hospital were approached for recruitment. Patients’ adherence to their medications was examined using a validated questionnaire during an interview between the principal investigator and the patients, where patients’ adherence to their selfcare activities was assessed using a developed, validated and previously published questionnaire as well. Reasons for lack of adherence was explored from the patients. Verification of patient’s details and medications was done via the patient’s hospital file. Results: The mean age of the participants (n=173) was 53.21 (SD= 8.61) years. Assessing patients’ adherence to medications showed that more than half of them stated that they sometimes/often forgot to take their medication/s, while 41.0% sometimes/often stopped their medication/s from time to time. The mean adherence to medications score (out of 28) was 18.39 (SD=2.1), with 83.8% having a low adherence level. It is found that patients who did not take their medications were due to forgetfulness (46.8%) and complications from taking the medications (20.2%). Better adherence was associated with higher educational level, higher number of medical conditions, and higher frequency of glucose monitoring. Adherence to self-care activities showed that majority of patients performed correct self-care activities three times a week. Conclusion: Post-stroke patients in Saudi Arabia have indicated low levels of medication adherence, while reporting good adherence to their self-care activities. Better adherence was associated with certain patient characteristics such as higher educational level. These findings can help in focusing the efforts to improve adherence and health outcomes for stroke patients in the future.
2. WHO. Stroke, Cerebrovascular accident. http://www.emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html
3. Ayasrah S, Ahmad M, Basheti I, et al. Post-stroke Anxiety Among Patients in Jordan: A Multihospital Study. J Geriatr Psychiatry Neurol. 2022;35(5):705-716. https://doi.org/10.1177/08919887211060015
4. Pompili M, Venturini P, Lamis DA, et al. Suicide in Stroke Survivors: Epidemiology and Prevention. Drugs and Aging.2015;32(1):21-29. https://doi.org/10.1007/s40266-014-0233-x
5. Almhdawi KA, Alazrai A, Kanaan S, et al. Post-stroke depression, anxiety, and stress symptoms and their associated factors: Across-sectional study. Neuropsychol Rehabil. 2021;31(7):1091-1104. https://doi.org/10.1080/09602011.2020.1760893
6. Rafsten L, Danielsson A, Sunnerhagen KS. Anxiety after stroke: A systematic review and meta-analysis. J Rehabil Med.2018;50(9):769-778. https://doi.org/10.2340/16501977-2384
7. Tuomilehto J, Rastenyte D. Diabetes and glucose intolerance as risk factors for stroke. J Cardiovasc Risk. 1999;6(4):241-49.https://doi.org/10.1177/204748739900600409
8. Hu G, Sarti C, Jousilahti P, et al. The Impact of History of Hypertension and Type 2 Diabetes at Baseline on the Incidence of Stroke and Stroke Mortality. Stroke. 2005;36(12):2538-2543. https://doi.org/10.1161/01.STR.0000190894.30964.75
9. Basheti IA, Al-Qudah RA, Obeidat NM, et al. Home medication management review in outpatients with chronic diseases in Jordan: a randomized control trial. Int J Clin Pharm. 2016;38(2):404-413. https://doi.org/10.1007/s11096-016-0266-9
10. Gallacher KI, Batty GD, McLean G, et al. Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden. BMC Med. 2014;12(1):1-9. https://doi.org/10.1186/s12916-014-0151-0
11. Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, andmedic al education: a cross-sectional study. Lancet. 2012;380(9836):37-43. https://doi.org/10.1016/S0140-6736(12)60240-2
12. Chambers JA, O’Carroll RE, Hamilton B, et al. Adherence to medication in stroke survivors: A qualitative comparison of low and high adherers. Br J Health Psychol. 2011;16(3):592-609. https://doi.org/10.1348/2044-8287.002000
13. Chapman B, Bogle V. Adherence to medication and self-management in stroke patients. Br J Nurs. 2014;23(3):158-166. https://doi.org/10.12968/bjon.2014.23.3.158
14. Nassar RI, Basheti IA, Saini B. Exploring Validated Self-Reported Instruments to Assess Adherence to Medications Used: AReview Comparing Existing Instruments. Patient Prefer Adherence. 2022;16(1):503-513. https://doi.org/10.2147/PPA.S352161
15. Ireland S, MacKenzie G, Gould L, et al. Nurse case management to improve risk reduction outcomes in a stroke prevention clinic. Can J Neurosci Nurs. 2011;33(1):14-27.
16. Adie K, James MA. Does telephone follow-up improve blood pressure after minor stroke or TIA? Age Ageing. 2010;39(5):598-603. https://doi.org/10.1093/ageing/afq085
17. Basheti IA, Ayasrah SM, Ahmad M. Identifying treatment related problems and associated factors among hospitalized poststroke patients through medication management review: a multi-center study. Saudi Pharm J. 2019;27(2):208-219. https://doi.org/10.1016/j.jsps.2018.10.005
18. Larson J, Franzén-Dahlin Å, Billing E, et al. The impact of a nurse-led support and education programme for spouses of stroke patients: a randomized controlled trial. J Clin Nurs. 2005;14(8 A):995-1003. https://doi.org/10.1111/j.1365-2702.2005.01206.x
19. AbuRuz SM, Bulatova NR, Yousef AM. Validation of a comprehensive classification tool for treatment-related problems. Pharm World Sci. 2006;28(4):222-232. https://doi.org/10.1007/s11096-006-9048-0
20. Basheti IA, Tadros OKI, Aburuz S. Value of a Community-Based Medication Management Review Service in Jordan: A ProspectiveRandomized Controlled Study. Pharmacotherapy. 2016;36(10):1075-1086. https://doi.org/10.1002/phar.1833
21. AbuRuz SM, Bulatova NR, Yousef AMM, et al. Comprehensive assessment of treatment related problems in hospitalized medicine patients in Jordan. Int J Clin Pharm. 2011;33(3):501-511. https://doi.org/10.1007/s11096-011-9497-y
22. Lehane E, McCarthy G. Medication non-adherence-exploring the conceptual mire. Int J Nurs Pract. 2009;15(1):25-31. https://doi.org/10.1111/j.1440-172X.2008.01722.x
23. Horne R. Compliance, Adherence, and Concordance: Implications for Asthma Treatment. Chest. 2006;130(1):65S-72S. https://doi.org/10.1378/chest.130.1_suppl.65S
24. Kaddumukasa M, Kayima J, Kaddumukasa MN, et al. Knowledge, attitudes and perceptions of stroke: a cross-sectional survey in rural and urban Uganda. BMC Res Notes. 2015;8(1):1-7. https://doi.org/10.1186/s13104-015-1820-6
25. Aljefree N, Ahmed F. Prevalence of Cardiovascular Disease and Associated Risk Factors among Adult Population in the Gulf Region: A Systematic Review. Adv Public Heal. 2015. https://doi.org/10.1155/2015/235101
26. Sundseth A, Faiz KW, Rønning OM, et al. Factors related to knowledge of stroke symptoms and risk factors in a norwegian stroke population. J Stroke Cerebrovasc Dis. 2014;23(7):1849-1855. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.02.026
27. Vincent-Onabajo G, Moses T. Knowledge of stroke risk factors among stroke survivors in Nigeria. Stroke Res Treat. 2016;2016:1902151. https://doi.org/10.1155/2016/1902151
28. Alhalaiqa F, Deane K, Nawafleh A, et al. Adherence therapy for medication non-compliant patients with hypertension: a randomised controlled trial. J Hum Hypertens. 2012;26(2):117-126. https://doi.org/10.1038/jhh.2010.133
29. Rolnick SJ, Pawloski PA, Hedblom BD, et al. Patient characteristics associated with medication adherence. Clin Med Res.2013;11(2):54-65. https://doi.org/10.3121/cmr.2013.1113
30. Bakken LN, Kim HS, Finset A, et al. Stroke patients’ functions in personal activities of daily living in relation to sleep and socio-demographic and clinical variables in the acute phase after first-time stroke and at six months of follow-up. J Clin Nurs. 2012;21(13-14):1886-1895. https://doi.org/10.1111/j.1365-2702.2011.04014.x
31. Gall SL, Tran PL, Martin K, et al. Sex Differences in Long-Term Outcomes After Stroke Functional Outcomes, Handicap, andQuality of Life. Stroke. 2012;43(7):1982-1987. https://doi.org/10.1161/STROKEAHA.111.632547
32. Moorley C. Life after stroke: personal, social and cultural factors - an inner city afro-caribbean experience. Univ East London. 2012.
33. Zaky HEM, Mohammad ZAE-L, EL-Labban AST, et al. Strategies of Daily Living Rehabilitative Activities for Post Stroke Patients at Minia University Hospital. J Educ Pract. 2015;6(5):61-72.
34. Buelt A, Richards A, Jones A. Hypertension: New Guidelines from the International Society of Hypertension. https://www.aafp. org/afp/2021/0615/p763.html
35. WHO. Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension
36. Lip GYH, Edwards SJ. Stroke prevention with aspirin, warfarin and ximelagatran in patients with non-valvular atrial fibrillation: A systematic review and meta-analysis. Thromb Res. 2006;118(3):321-333. https://doi.org/10.1016/j.thromres.2005.08.007
37. Yao X, Abraham NS, Alexander GC, et al. Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation. J Am Heart Assoc. 2016;5(2):1-12. https://doi.org/10.1161/JAHA.115.003074
38. Gumbinger C, Holstein T, Stock C, et al. Reasons underlying non-adherence to and discontinuation of anticoagulation in secondary stroke prevention among patients with atrial fibrillation. Eur Neurol. 2015;73(3-4):184-191. https://doi. org/10.1159/000371574
39. Svensson S, Kjellgren KI, Ahlner J, et al. Reasons for adherence with antihypertensive medication. Int J Cardiol. 2000;76(2-3):157-163. https://doi.org/10.1016/s0167-5273(00)00374-0
40. Millenaar D, Schumacher H, Brueckmann M, et al. Cardiovascular Outcomes According to Polypharmacy and Drug Adherence in Patients with Atrial Fibrillation on Long-Term Anticoagulation (from the RE-LY Trial). Am J Cardiol. 2021;149:27-35. https:// doi.org/10.1016/j.amjcard.2021.03.024
41. Basheti IA, Qunaibi EA, Bulatova NR, et al. Treatment related problems for outpatients with chronic diseases in Jordan: The value of home medication reviews. Int J Clin Pharm. 2013;35(1):92-100. https://doi.org/10.1007/s11096-012-9713-4
42. Al alawneh M, Nuaimi N, Basheti IA. Pharmacists in humanitarian crisis settings: Assessing the impact of pharmacistdelivered home medication management review service to Syrian refugees in Jordan. Res Soc Adm Pharm. 2019;15(2):164-172. https://doi.org/10.1016/j.sapharm.2018.04.008
43. Basheti IA, Rizik M, Bulatova NR. Home medication management review in outpatients with alarming health issues in Jordan:a randomized control trial. J Pharm Heal Serv Res. 2018;9(2):91-100.
44. Lakshmi R, James E, Kirthivasan R. Study on Impact of Clinical Pharmacist’s Interventions in the Optimal Use of Oral Anticoagulants in Stroke Patients. Indian J Pharm Sci. 2013;75(1):53-59. https://doi.org/10.4103/0250-474X.113550
45. Abu Kamel AA, Mohammed H. Evaluation of Home Caregiving Program by Jordanian Stroke Patients’ Caregivers: Qualitative Study. J Nat Sci Res. 2014;4(22):25-34.