Impact of a Pluriprofessional Intervention to Improve Medication Adherence (Secondary Preventive Medication) in Patients After Ischemic Stroke

Hospices Civils de Lyon182 enrolled

Overview

Medication adherence is a major factor to prevent vascular recurrence after a first ischemic stroke. Nevertheless, it is suboptimal and the implementation of specific interventions are needed to improve it. A patient - centered and pluriprofessional structured intervention, targeting the medication, introduced at hospital discharge and continued at home (by regular telephone contact) could improve medication adherence one year after stroke. This intervention would consist of semi structured interviews patient-pharmacist at different times during one year after stroke. The information about the therapeutic management of the patient will be shared between healthcare professionals : general practitioners (GP) and community pharmacists (CP), hospital clinical pharmacist (HCP) and physician (HPhys). It will allow for decrease of the recurrent stroke and others cardiovascular complications based on a better adherence to preventive medication. Furthermore the decrease of the iatrogenic events and the improvement of the quality of life of patients may be also associated.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

182

Conditions

Ischemic Stroke

Interventions

Initial interview with pharmacist (at the hospital discharge): Evaluation aimed to identify barriers to adherence to drug treatment followed by an information session on the disease, the benefit of drugs and the importance of diet and lifestyle habits. Pharmacist advices focused on how to take medication and how to manage adverse events will be provided. Telephone interviews with hospital clinical pharmacist - patient (at M3 M6 and M9): The objective is to review with the patient its medication-taking routine and its potential difficulties, to motivate adherence to treatment and lifestyle/dietary rules, to give advices about therapeutics and how to take medication. HCP contacts CP to determine the prescription refill. Final interview with HCP pharmacist (at M12): The objective is to take stock with the patient about its taking drug load.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Aged ≥ 18 years * Patient with ischemic stroke hospitalized in physical medicine and rehabilitation unit or neurovascular unit * Return at home at the hospital discharge * Medication including an antiplatelet drug or an oral anticoagulant with at least an antihypertensive drug and/or a lipid lowering agent (statin) * Patient without either cognitive disorders or major psychiatric disorders * Patient with a sufficient autonomy for the management of medication at home (score of Barthel \> 30) Exclusion Criteria: * Patient ≤ 18 years * Patient with important cognitive or psychiatric disorders * Management of patient medication exclusively by the helper * No usual pharmacy (or more than 2 usual pharmacies) * Patient directed to an institution at the end of the hospitalization

Locations (6)

Service de neurologie vasculaire, Hôpital P Wertheimer, HCL

Bron, France

RECRUITING

Service de médecine physique et de réadaptation, Hôpital Nord, CHU de Clermont Ferrand

Cébazat, France

RECRUITING

Service de médecine physique et de réadaptation, Hôpital sud, CHU de Grenoble

Échirolles, France

RECRUITING

Service de médecine physique et de réadaptation, Groupe hospitalier Lariboisière - Fernand Vidal, AP-HP

Paris, France

RECRUITING

Service de médecine physique et de réadaptation, Hôpital Bellevue, CHU Saint Etienne

Saint-Etienne, France

NOT_YET_RECRUITING

Service de médecine physique et de réadaptation, Hôpital Henry Gabrielle, Groupement Hospitalier Sud, HCL

Saint-Genis-Laval, France

RECRUITING

Outcomes

Primary Outcomes

Measure of patient's adherence to medication. This adherence measurement is a composite measure

A patient will be considered adherent if: 1. For each secondary-preventive drug (antiplatelet, lipid lowering, and antihypertensive), evaluated by the pharmacy refills: Number of days of medication available to the patient (supplied by the pharmacy divided by the total number of days in the period of the study (365)), is higher than 80%. 2. And score obtained from self-reported adherence questionnaire, greater than 6/8 is obtained for all secondary preventative medication

Time frame: One year after inclusion

Secondary Outcomes

Analysis of pharmacy refills

To estimate the benefit of the intervention on the adherence for each drug, number of days of medication available to the patient (supplied by the pharmacy) divided by the total number of days in the period of the study (365) is higher than 80%.