None listed
Conditions
Brief summary
Medications recommended to reduce the risk of a subsequent stroke are prescribed after a stroke or Transient Ischemic event (TIA). To gain most benefit, patients need to be able to self-manage these medications. That is; to organize continued supply of these medications with their general practitioner and community pharmacy, to take them as agreed with the prescriber and to be able to communicate any unwanted effects they may experience. The primary aim of this study is to determine if a “patient centred educational exchange” added to usual care improves adherence to prescribed medications for secondary prevention for stroke patients compared with usual care. We have a number of secondary aims to investigate the further impact of this relationship based model of information exchange on sustaining adherence, self-reported medication taking behaviour, clinical outcomes, quality of life, changes in knowledge, beliefs towards medicines and illness and to determine the cost of the model. Patients who have been admitted to the Stroke Unit, Princess Alexandra Hospital, with a diagnosis of stroke or TIA and who are being discharged back to their own home will be approached to participate in this study. Participation in this project will involve completing a questionnaire on three or four occasions. The first will be before the participant is discharged from hospital, the second will take place over the telephone about 3 months after discharge and the third over telephone at 12 months after discharge. The questionnaire will take about fifteen minutes to complete. The questionnaire contains questions related to the participant’s quality of life, the participant’s views of stroke, the participant’s view and opinion of their medicines prescribed to reduce the risk of stroke and questions on the way the participant takes their stroke prevention medications. The telephone interviews will also ask questions about GP and Hospital visits, perceived medication related problems, Blood Pressure and Cholesterol results if known. About half of the participants in this study will be chosen (by randomisation) to have a longer interview with the researcher before discharge from hospital. This will be a conversation about the participants’ stroke medications. These participants will also be contacted by telephone approximately ten days after discharge from hospital. The telephone call will involve the same questionnaire, a conversation about their stroke medications and an opportunity to follow-up on any questions the participants’ may have about their medicines.
Interventions
The intervention comprises two patient centred educational exchange sessions (based on social marketing/academic detailing principals) conducted by the research pharmacist; one session is conducted face to face before discharge and one by telephone approximately ten days after discharge.
The first part of the sessions has structured questions from previously validated questionnaires to identify patients’ beliefs about their stroke in general (using the brief-Illness Perception Questionnaire (br
The intervention comprises two patient centred educational exchange sessions (based on social marketing/academic detailing principals) conducted by the research pharmacist; one session is conducted face to face before discharge and one by telephone approximately ten days after discharge. The first part of the sessions has structured questions from previously validated questionnaires to identify patients’ beliefs about their stroke in general (using the brief-Illness Perception Questionnaire (brief- IPQ)) and medications in particular(using the Beliefs about Medicine questionnaire specific (BMQ-specific) to identify necessity and concern beliefs. There is also an opportunity for the patient to self-report their previous medication taking behavior (using the Medication Adherence Questionnaire (MAQ)) of the medications of interest. The identified concerns (which can be barriers) and necessities (which can be enablers) identified from the validated questionnaires are taken into account and can be referred to in a brief personalised conversation using a two sided single page document given to the participant (the detailing tool) to outline each of up to three (stroke prevention) medications the patient is taking and the delivery of four a-priori key messages. This expected to take a total of twenty to thirty minutes both for the face to face session and for the telephone follow-up session.
Sponsors
Judith Coombes
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
aged 18 years or older, have been admitted under the “Medical Stroke Unit” or "Medical Admission and Planning Unit" at Princess Alexandra Hospital, with a principal diagnosis of Stroke or TIA, planned to be discharged to their home. patient manages their medication, patient has a Mental Status Questionnaire (MSQ) score of 10/10 on the Neurological Observation Chart the patient is able to provide consent.
Exclusion criteria
Those patients planned for discharge to a residential care facility (eg a nursing or residential care home) where a staff member is responsible for the patients’ medication administration those unable to complete the questionnaire (even) with assistance (this may be due to language difficulties or cognitive impairment) those who do not wish to take part.
Outcome results
None listed