A Qualitative Study of Barriers and Facilitators to Adherence to Secondary Prevention Medications Among French Patients Suffering from Stroke and Transient Ischemic Attack

Marie Viprey; Maïlys Gouillet; Costanza Puppo; Anne Termoz; Claire Della Vecchia; Laurent Derex; Julie Haesebaert; Anne-Marie Schott; Marie Préau

doi:10.2147/PPA.S257323

A Qualitative Study of Barriers and Facilitators to Adherence to Secondary Prevention Medications Among French Patients Suffering from Stroke and Transient Ischemic Attack

Patient Prefer Adherence. 2020 Jul 21:14:1213-1223. doi: 10.2147/PPA.S257323. eCollection 2020.

Authors

Marie Viprey^{1

2}, Maïlys Gouillet³, Costanza Puppo³, Anne Termoz^{1

2}, Claire Della Vecchia^{2

3}, Laurent Derex^{2

4}, Julie Haesebaert^{1

2}, Anne-Marie Schott^{1

2}, Marie Préau³

Affiliations

¹ Public Health Department, Hospices Civils de Lyon, Lyon, France.
² HESPER EA 7425, University of Lyon, University Claude Bernard Lyon 1, Lyon, France.
³ GRePS, Lyon 2 University, Lyon, France.
⁴ Comprehensive Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.

Abstract

Purpose: Secondary prevention medications (SPM) reduce the risk of ischemic stroke (IS) and transient ischemic attack (TIA) recurrence. However, approximately one-third of patients are estimated to be non-adherent. This qualitative study aimed to explore barriers and facilitators to adherence to SPM after IS or TIA.

Patients and methods: Thirty-six face-to-face semi-structured interviews were conducted with 14 TIA patients and 22 IS patients who self-administered their treatment 12 months after IS/TIA. A thematic analysis was performed.

Results: Major facilitators to good adherence to SPM were the fear of stroke recurrence and the high level of trust in the prescribing physician. Barriers included a perceived lack and/or inappropriate timing of information about SPM, practical difficulties of taking some SPM (eg, inadequate packaging) and of implementing routines into their daily life.

Conclusion: Information on SPM is inadequate in terms of quantity and timing both during the acute IS/TIA period and over the long term. Providing more tailor-made information at an opportune moment, in particular by promoting discussion with their general practitioner (GP) throughout the course of illness and recovery, is essential to ensure that patients are not left alone in the decision-making process regarding adherence to SPM.

Keywords: medication adherence; qualitative study; stroke; transient ischemic attack.

Grants and funding

This work was supported by public funding from the Programme de recherche sur la performance du système des soins (PREPS 16-0592) and performed within the framework of RHU MARVELOUS (ANR-16-RHUS-0009) UCBL, as part of the program “Investissements d’Avenir” operated by the French National Research Agency (ANR).