Abstract WP237: Facilitators and Barriers to Medication Adherence Among Stroke Survivors in India

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shani SD ◽  
Vr Kutty ◽  
Rp Varma ◽  
Jissa VT ◽  
Sylaja PN

Background: Medication nonadherence is a major problem and is an important mediator between the treatment and the outcome. Strict compliance with medication and life style modification are integral to secondary stroke prevention. Methods: Cross sectional survey among 240 stroke survivors within a post-stroke period of three months to one year was conducted. Interview based self-reported medication adherence was defined as consumption at least more than 80% of their medication, based on their last prescription. Medication adherence was calculated for five categories of medication; antiplatelets, antihypertensives, antidiabetics, statin and anticoagulants. Overall adherence was defined as adherence to all the categories of medications prescribed. Structured interview using pretested interview schedule was done to collect sociodemographic data, health care seeking behaviour, life style, facilitators and barriers to medication adherence. Results: Stroke survivors [n=240; mean age 58.64 ±10.96 years); 25.4% females; post-stroke period of 6.65±3.36 months] were interviewed. Patients with diabetes, hypertension and dyslipidaemia constituted 64.2%, 88.8% and 96.7% and optimal control was achieved in 26%, 36.2% and 72.9% respectively. Overall medication adherence was 43.8% (n=240). Adherence to antiplatelet was 62.24% (n=196). Medication adherence was 34.4% (n=134), 52.6% (n=190) and 56.7% (n=224) for antidiabetics, antihypertensives and statins respectively and was associated with risk factor control (Diabetes: Odds Ratio(OR)=4.85;95% Confidence Interval(CI) 2.12-11.08, Hypertension: OR=3.42; 95% CI 1.83-6.4, Dyslipidaemia: OR=3.88;95% CI 1.96-7.69). Having daily routines (OR=2.82;95% CI 1.52-5.25), perceived need of medication (OR= 2.33;95% CI 1.04-5.2) and perceived poor state of health (OR= 3.09; 95% CI 1.44-6.62) as facilitators. Memory problem (OR 0.32; 95% CI 0.51-0.66), experiencing side effects (OR 0.24; 95% CI 0.11-0.53) and belonging to below poverty line (OR 0.46; 95% CI 0.24-0.91) were barriers to medication adherence. Conclusion: Establishing daily routines, periodic reminders, and financial supports to buy medicines and patient education can enhance medication adherence to prevent future strokes.

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033066 ◽  
Author(s):  
Karen Thomas ◽  
Clarissa Hjalmarsson ◽  
Ricky Mullis ◽  
Jonathan Mant

With survival after stroke improving, more people are discharged into the community with multiple and persistent deficits. Fatigue is a common unmet need for stroke survivors, but there are no evidence-based guidelines for its assessment and management. This study explored how UK-based therapists conceptualise post-stroke fatigue (PSF) in current practice.ObjectiveTo describe current understanding of PSF among physiotherapists (PT) and occupational therapists (OT).DesignA cross-sectional online survey using Qualtrics software (a survey creation and analysis programme) was sent to therapists working with stroke survivors in 2019. Responses to the open ended question, ‘How would you describe PSF if approached by another healthcare professional?’ were analysed thematically by two independent researchers.Participants137 survey respondents (71 PT and 66 OT) from a range of clinical settings (25 acute care, 24 sub-acute rehabilitation care, 3 primary care and 85 community care) with 7 months-36 years of experience working with stroke survivors completed the survey.ResultsRespondents stated that PSF should be regarded as an important medical condition because it is common and can be associated with severe symptoms. Symptoms were perceived to be highly variable and the syndrome was difficult to define objectively. It was felt to have both physical and cognitive components. A variety of different opinions were expressed with regard to causation, conceptualisation and best management.ConclusionTherapists working with stroke survivors conceptualise and manage PSF in different ways. Clinical practice is hampered by a lack of a widely adopted definition, and a small evidence base. Research into causes and management of PSF is a priority.


2017 ◽  
Vol 50 (06) ◽  
pp. e1-e1
Author(s):  
Nobuhiro Nagai ◽  
Hideaki Tani ◽  
Takefumi Suzuki ◽  
Saeko Ikai ◽  
Philip Gerretsen ◽  
...  

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Grace Vincent-Onabajo ◽  
Taritei Moses

Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke—whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors.Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk factor) was assessed using open-ended questionnaire. Data were treated with descriptive statistics and logistic regression analysis.Results. Sixty-nine stroke survivors (male = 72.5%; mean ± SD age =49.7±10.6years) participated in the study. Thirty-four (49.4%) participants had knowledge of stroke risk factors. Only educational level was significantly associated with knowledge and participants with tertiary educational qualification were about 48 times (odds ratio = 48.5; CI = 7.6–309.8;P<0.0001) more likely to be knowledgeable than those with no education.Conclusion. Less than half of the participants had knowledge of stroke risk factors. Participants with tertiary education were significantly more knowledgeable than those with lower educational qualifications. Effective means of educating stroke survivors on stroke risk factors should be identified and adopted.


Jurnal NERS ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 66
Author(s):  
Susy Katikana Sebayang ◽  
Erni Astutik ◽  
Desak Made Sintha Kurnia Dewi ◽  
Ayik Mirayanti Mandagi ◽  
Septa Indra Puspikawati

Introduction:  Improving health care-seeking behavior of the coastal communities is a pathway to improve their health. This analysis aims to explore the health care-seeking behavior of the coastal communities in Banyuwangi District to recommend the room for improvement for health promotion and health service improvement for these communities. Method: Data from a cross-sectional survey of metabolic syndrome and mental health conducted in coastal communities in Banyuwangi was used for analysis.  Randomly selected participants from a list of members of Family Welfare Development Group (Pembinaan Kesejahteraan Keluarga /PKK) were asked for an interview at corresponding village office in Ketapang, Bangsring, Bulu Agung, Grajagan and Kampung Mandar village.  Distribution of health care-seeking behaviors was analyzed individually and where possible were segregated by gender and age. Results: More than half of the coastal communities in Banyuwangi District went to health care service to seek health and 7 out of 10 turned to health care service to seek health for their family members.  Women more than men turned to health care service when they or their family members fell ill.  Private doctors rather than Puskesmas were more popular.  Private midwives were the most popular service for antenatal care (ANC) and delivery.  Although there was not a clear increase in health care service utilization over time, we found that contraceptive utilization increased with time. Conclusion: The utilization of health care service in Banyuwangi needs to be more promoted especially for men’s health.  


Author(s):  
Shanthi Edward ◽  
Praveena Periasamy

Background: Advocates, being stressed out and depressed in the law profession due to unstable work pattern, work overload and lack in coping up skills. They thrive a lot to survive in the profession. In such circumstances, lawyers may lean on alcohol or tobacco. In view of above issues, one of the main objectives of the study is to evaluate the association between use of alcohol, tobacco, smoking and hypertension among practising advocates.Methods: A cross-sectional study was conducted in a sample of 300 practising advocates at Madurai district court for a period of 1 year by simple random sampling method. Data was collected using structured interview schedule and analysed using SPSS.Results: Around 263 (87.66%) study participants were non-smokers and 37 (12.33%) were tobacco smokers. Among the tobacco smokers, a majority of 24 (64.86%) were found to be hypertensives (p=0.002). In the current study among the alcohol consumers, a majority of 26 (55.32%) were hypertensives and among the non-consumers of alcohol, only 38.34% were hypertensives (p=0.044).Conclusions: Advocates being professionals are well educated, informative and aware of complications. Adoption of healthy life style practices, the prevalence of hypertension may be reduced among the advocate community. Life style modifications such as cessation of smoking, alcohol and tobacco should be adopted. Promotive activities like arrangement of health camps in the court, health education, counselling on self-care, stress bursting leisure time activities would reduce the dependency on tobacco and alcohol.


2021 ◽  
Author(s):  
Lily Payvandi ◽  
Chase Parsons ◽  
Fabienne C. Bourgeois ◽  
Jonathan Hron

BACKGROUND Limited English proficient (LEP) patients are at higher risk of poor health outcomes and are less likely to utilize telehealth compared to English speaking patients. There is no formal evaluation of inpatient telehealth user experience by language preference to date. OBJECTIVE To compare the experience of Spanish and English-speaking patients and families using our inpatient telehealth program (ITP). To evaluate the experience of Spanish interpreters using ITP. METHODS We prospectively administered a survey to English and Spanish speaking patients and families who used our ITP from October 1, 2020 to March 31, 2021. We performed semi-structured interviews of hospital based Spanish interpreters by phone who participated in ITP. RESULTS High satisfaction was reported by both English and Spanish speakers (SD 0.47-1.7, IQR 0-2). Both English and Spanish speaking patients participated in ITP with their primary inpatient care team, subspecialty consultants and other clinicians. Hospital tablets were used more often than personal devices, and only English speaking patients utilized a personal laptop. Patients and families encountered challenges with log-in, team coordination with multiple users and equipment availability. Interpreters encountered challenges with audio and visual quality, communication, safety, and Wi-fi access. CONCLUSIONS There is high satisfaction amongst both English and Spanish speaking patients using our ITP. Use cases are multi-disciplinary and suggest lasting applicability post-pandemic, however significant investment is needed to provide robust infrastructure to support utilization by all patients, but especially integration of interpreter services for LEP patients. CLINICALTRIAL N/A


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Adedapo Olufemi Bashorun ◽  
Christopher Linda ◽  
Semeeh Omoleke ◽  
Lindsay Kendall ◽  
Simon D. Donkor ◽  
...  

Abstract Background Early diagnosis and treatment of tuberculosis (TB) are the mainstay of global and national TB control efforts. However, the gap between expected and reported cases persists for various reasons attributable to the TB services and care-seeking sides of the TB care cascade. Understanding individual and collective perspectives of knowledge, attitudes, beliefs and other social circumstances around TB can inform an evidence-based approach in engaging communities and enhance their participation in TB case detection and treatment. Methods The study was conducted during the Gambian survey of TB prevalence. This was a nationwide cross-sectional multistage cluster survey with 43,100 participants aged ≥15 years in 80 clusters. The study sample, a random selection of 10% of the survey population within each cluster responded to a semi-structured questionnaire administered by trained fieldworkers to assess the knowledge, attitudes and practice of the participants towards TB. Overall knowledge, attitude and practice scores were dichotomised using the computed mean scores and analysed using descriptive, univariable and multivariable logistic regression. Results All targeted participants (4309) were interviewed. Majority were females 2553 (59.2%), married 2614 (60.7%), had some form of education 2457 (57%), and were unemployed 2368 (55%). Although 3617 (83.9%) of the participants had heard about TB, only 2883 (66.9%) were considered to have good knowledge of TB. Overall 3320 (77%) had unfavourable attitudes towards TB, including 1896 (44%) who indicated a preference for staying away from persons with TB rather than helping them. However, 3607(83.7%) appeared to have the appropriate health-seeking behaviours with regard to TB as 4157 (96.5%) of them were willing to go to the health facility if they had symptoms suggestive of TB. Conclusions About 3 in 10 Gambians had poor knowledge on TB, and significant stigma towards TB and persons with TB persists. Interventions to improve TB knowledge and address stigma are required as part of efforts to reduce the burden of undiagnosed TB in the country.


2018 ◽  
Vol 7 (4) ◽  
pp. 177-181 ◽  
Author(s):  
Ancy M Das ◽  
Lakshmi Ramamoorthy ◽  
Sunil k. Narayan ◽  
Vaibhav Wadwekar

Introduction: Epilepsy is a treatable and curable brain disorder. However major proportion of individuals with this disease in developing countries receives no treatment because of misunderstandings of the public. Other than that, poor adherence to ordered medication is considered the primary cause of drug therapy failure in epilepsy. This study conducted to assess the adherence pattern to antiepileptic regimen, among patients with epilepsy and to identify the clinical and patient-related factors contributing as barriers. Methods: A cross sectional survey design was used in 100 epilepsy patients in an Outpatient unit of tertiary care center. A Convenient sampling technique was used to enroll the patients who meet inclusion criteria. Structured interview with pre-tested questionnaire and eight item Morisky Medication Adherence Scale was used to collect the data. Descriptive and inferential statistics were used for analysis of data. Descriptive statistics (mean, standard deviation, frequency and percentages) were used to describe the clinical and demographic variables of study participants. The determinants of medication adherence were analyzed using Chi-Square test and independent student t- test. The analysis was done with SPSS 20th version. Results: Majority (71%) of patients were not adherent to antiepileptic treatment. Severity of seizure (indicated by the presence of seizure last year), medication frequency and complexity of treatment were found to have significant association with the Anti-Epileptic Drugs (AED) adherence status. Status of adherence is significantly associated with frequency of seizure/year and positive life style. Conclusion: As Medication adherence was observed to be low, services for adherence counseling and health educational interventions in the epilepsy clinics is recommended.


BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e032652
Author(s):  
Corrina Moucheraud ◽  
Matthew Hing ◽  
Juliet Seleman ◽  
Khumbo Phiri ◽  
Florence Chibwana ◽  
...  

ObjectivesAs HIV-positive individuals’ life expectancy extends, there is an urgent need to manage other chronic conditions during HIV care. We assessed the care-seeking experiences and costs of adults receiving treatment for both HIV and hypertension in Malawi.Design, setting and participantsA cross-sectional survey was conducted with HIV-positive adults with hypertension at a health facility in Lilongwe that offers free HIV care and free hypertension screening, with antihypertensives available for purchase (n=199). Questions included locations and costs of all medication refills and preferences for these refill locations. Respondents were classified as using ‘integrated care’ if they refilled HIV and antihypertensive medications simultaneously. Data were collected between June and December 2017.ResultsOnly half of respondents reported using the integrated care offered at the study site. Among individuals using different locations for antihypertensive medication refills, the most frequent locations were drug stores and public sector health facilities which were commonly selected due to greater convenience and lower medication costs. Although the number of antihypertensive medications was equivalent between the integrated and non-integrated care groups, the annual total cost of care differed substantially (approximately US$21 in integrated care vs US$90 for non-integrated care)—mainly attributable to differences in other visit costs for non-integrated care (transportation, lost wages, childcare). One-third of those in the non-integrated care group reported no expenditure for antihypertensive medication, and six people in each group reported no annual hypertension care-seeking costs at all.ConclusionsIndividuals using integrated care saw efficiencies because, although they were more likely to pay for antihypertensive medications, they did not incur additional costs. These results suggest that preferences and experiences must be better understood to design effective policies and programmes for integrated care among adults on antiretroviral therapy.


2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Netsanet Shiferaw ◽  
Mohamad I. Brooks ◽  
Graciela Salvador-Davila ◽  
Shumet Lonsako ◽  
Konjit Kassahun ◽  
...  

Introduction. Cervical cancer is one of the leading causes of cancer death among Ethiopian women. Low awareness of cervical cancer, in combination with low health care seeking behavior, is a key challenge for cervical cancer prevention. This study assessed the knowledge of cervical cancer among HIV-infected women in Ethiopia. Methods. A facility-based cross-sectional survey was conducted from August to September 2012 among HIV-infected women between 21 and 49 years of age. Basic descriptive statistics were performed using SPSS. Results. A total of 432 HIV-infected women participated in this study. About 71% of participants had ever heard of cervical cancer. Among women who had ever heard of cervical cancer, 49% did not know the cause while 74% were able to identify at least one risk factor for cervical cancer. Only 33% of women were able to correctly address when women should seek care and 33% identified at least one treatment option for cervical cancer. Conclusion. This study revealed that knowledge about cervical cancer was generally low, in particular for health care seeking behavior and treatment of cervical cancer. Health awareness programs should be strengthened at both community and health facility levels with emphasis highlighting the causes, risk factors, care seeking behaviors, and treatment options for cervical cancer.


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