More information on medication changes may improve post-discharge adherence in patients with stroke

Providing more details to primary care physicians (PCPs) about medication changes during hospitalization can help improve adherence after discharge, according to a new study.

Researchers performed an open, prospective, interventional two-phase study at a clinic in Germany to examine adherence to discharge medication in patients with ischemic stroke. Adherence was evaluated before and after implementation of a systematic intervention administered by a clinical pharmacist.

Patients were included in the study if they had a transient ischemic attack or ischemic stroke and were taking at least two drugs during their hospital stay and at discharge. The first phase of the study, involving the control group, took place from January 2011 to June 2011. The second phase, involving the intervention group, took place from October 2011 to March 2012.

Patients in the control group received a letter at discharge meant to inform their PCP about their main diagnosis, any diagnostic findings, laboratory test results, complications and medications. Patients in the intervention group received a letter in which a clinical pharmacist listed medications at both admission and discharge and detailed the reasons behind all changes that occurred during the hospital stay, including reasons for any new drugs, discontinued drugs, and modifications, particularly antithrombotic drugs and simvastatin.

After three months, patients' PCPs were interviewed about patients' current medication lists to evaluate adherence to the medications included in the discharge letter, defined as continued therapy from discharge to three months. The study results were published online Dec. 6 by Stroke.

A total of 312 patients, 156 in each group, were included in the study. The mean age was 70.7 in the control group and 72.3 in the intervention group, and slightly over half of the patients in each group were men. Overall adherence to the medications in the discharge letter increased from 83.3% in the control group to 90.9% in the intervention group (P=0.01). Adherence to antithrombotic drugs and statin therapy both differed significantly between the control and intervention groups (83.8% vs. 91.9% and 69.8% vs. 87.7%; P=0.033 and P<0.001, respectively).

The authors stated that medication adherence after discharge appears to be better when more information about medication changes is provided. They speculated that PCPs' adherence to discharge medications was better because they were given the rationale behind the changes made during hospitalization.

They specifically noted the difference in statin therapy between groups, with fewer discontinuations or dosage reductions, writing that the higher adherence rate in the intervention group reflected physicians' improved awareness of the benefits of statins after a cerebrovascular event.

“Providing detailed information on medication changes can lead to substantially improved adherence to discharge medication, probably resulting in better secondary stroke prevention,” the authors concluded.