지역사회 뇌졸중 환자들의 이차 예방을 위한 치료 지속률과 약물 순응도 관련 요인

Abstract

Objectives: This study aimed to explore the persistence and adherence to secondary preventive medicationof stroke patients after discharge and to assess the reasons for persistence and nonadherence. Methods: Four hundred twenty-nine patients with stroke were surveyed to determine their behaviors fromdischarge. Reasons for stopping medications were ascertained. Persistence was defined as continuation of allsecondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribedmedications according to health care provider instructions. Results: Of the 429 patients, 86.5% were treatment persistent and 41.2%(non-intentional nonadherence=39.4%,intentional nonadherence=19.4%) were adherent. Independent predictors of persistence included havingexperience about health education. Independent predictors of non-intentional nonadherence were modifiedRankin Scale(mRS) (Exp(B)=2.858, p=0.001) and health education experience (Exp(B)=0.472, p=0.032), andindependent predictors of intentional nonadherence were mRS (Exp(B)=2.533, p=0.006), depressive symptoms(Exp(B)=1.113, p=0.016), beliefs about medications questionnaire(necessity, Exp(B)=0.879, p=0.011, concern,Exp(B)=1.098, p=0.019). Conclusions: Although up to one-ninth of stroke patients continued secondary prevention medications,nonadherence is common. Several potentially modifiable patient, provider, and system-level factors associatedwith persistence and adherence may be targets for future interventions. Specially, interventions to improveadherence should target patients’ beliefs about their medication.