̽��ֱ�� of Cambridge - James Jamison

One in ten stroke survivors need more help with taking medication

cjb250 — Mon, 12 Mar 2018 02:51:21 +0000

According to the Stroke Associations, as many as four in ten people who have had a stroke, go on to have another one within ten years. As a second stroke carries a greater risk of disability and death than first time strokes, it is important that survivors take medicine daily to lower their risk. There are around 1.2 million stroke survivors in the UK, and at least a third suffer from severe impairments, potentially making adherence to their medicine difficult.

Half of survivors of stroke are dependent on others for everyday activities, though the proportion dependent on others for medicine taking or needing more practical help with tablets is not known.

To examine the practical support stroke survivors living in the community need and receive with taking their medicines, researchers at the ̽��ֱ�� of Cambridge and Queen Mary ̽��ֱ�� of London carried out a postal questionnaire study. ̽��ֱ��researchers developed the questionnaire together with stroke survivors and caregivers. ̽��ֱ��questionnaire was completed by 600 participants across 18 GP practices in the UK.

More than half (56%) of respondents needed help with taking medication. This included help with prescriptions and collection of medicines (50%), getting medicines out of the packaging (28%), being reminded to take medicines (36%), swallowing medicines (20%) and checking that medicines have been taken (34%). Being dependent on others was linked to experiencing more unmet needs with daily medicine taking.

Around one in ten (11%) of respondents answered yes to the question “Do you feel you need more help?” ̽��ֱ��most commonly reported areas where respondents said they needed more assistance were being reminded to take medicines, dealing with prescriptions and collection of medicines, and getting medicines out the packaging. As a result, around one in three (35%) of respondents said they had missed taking medicine in the previous 30 days.

Stroke survivors taking a higher number of daily medicines and experiencing a greater number unmet needs with practical aspects of medicine-taking were more likely to miss medications.

Interestingly, the researchers found that younger stroke survivors were more likely to miss their medicines, possibly because they are less likely to receive help from a caregiver.

“Because of the risk of a second stroke, it’s important that stroke survivors take their medication, but our study has shown that this can present challenges,” says Dr Anna De Simoni from the ̽��ֱ�� of Cambridge and Queen Mary ̽��ֱ�� of London. “In the majority of cases, they receive the help they need, but there is still a sizeable minority who don’t receive all the assistance they need.”

James Jamison at the Department of Public Health and Primary Care, ̽��ֱ�� of Cambridge, who led the study as part of his PhD, adds: “Our study has shown us some of the barriers that people face to taking their medication regularly. We also learned that stroke survivors who are dependent on others are most likely to need more assistance than they currently receive.

“Our response rate was relatively low – just over one in three – so we need more research to find out if what we’ve heard from our respondents is widespread among stroke survivors. If so, this will have implications for the care provided.”

̽��ֱ��team point to the need to develop new interventions focused on the practicalities of taking medicines and aimed at improving stroke survivors’ adherence to treatment. “Advances in technology have the potential to help improve adherence, such as electronic devices prompting medication taking times,” says Jamison. “Efforts to improve medication taking among survivors of stroke using technology are already underway and have shown promise.”

̽��ֱ��research was supported by the Royal College of General Practitioners, National Institute for Health Research (NIHR), the Stroke Association and the British Heart Foundation.

Reference
Jamison J, Ayerbe L, Di Tanna GL, Sutton S, Mant J, De Simoni A. Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: A survey. 2018 BMJ Open. DOI: 10.1136/bmjopen-2017-019874

Over a half of stroke patients require a degree of help with taking medicine and a sizeable minority say they do not receive as much assistance as they need, according a study published today in the journal BMJ Open.

Because of the risk of a second stroke, it’s important that stroke survivors take their medication, but our study has shown that this can present challenges

Anna De Simoni

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Researcher profile: James Jamison

James’ research seeks to understand why people sometimes do not take the medications prescribed by their GP – and then to use this to inform interventions aimed at improving their medication taking practices.

His day-to-day activities are very varied, he says. “They can involve anything from the development of research proposals, liaising with GP practices and pharmacies in the East of England to set up research studies, training health care professionals in research procedures, conducting interviews with patients, collecting questionnaire data or writing up research for publications in health care journals.”

However, the most rewarding and interesting part is coming face-to-face with stroke survivors and their caregivers to talk about their condition and the daily challenges they face, he adds.

“Working at Cambridge provides the opportunity to be part of a leading department conducting research in primary care and offers the potential to work with esteemed colleagues in the field,” he says. “ ̽��ֱ��opportunity to deliver high quality research outputs and undertake collaborations will hopefully help further my career as a successful health care researcher.”

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Concerns over side effects of statins stopping stroke survivors taking medication

cjb250 — Mon, 17 Jul 2017 08:19:58 +0000

Individuals who have had a stroke are at risk of a second stroke, which carries a greater risk of disability and death than first time strokes. In fact, one third of all strokes occur in individuals who have previously had a stroke. To prevent this recurrence, patients are offered secondary preventative medications; however, adherence is a problem with 30% of stroke patients failing to take their medications as prescribed.

To examine the barriers to taking these medications, researchers at the ̽��ֱ�� of Cambridge and Queen Mary ̽��ֱ��, London (QMUL), analysed posts to TalkStroke, a UK-based online forum hosted by the Stroke Association, across a seven year period (2004-2011). ̽��ֱ��forum was used by stroke survivors and their carers.

̽��ֱ��team, led by Dr Anna De Simoni, a lecturer in Primary Care Research at QMUL and visiting researcher at the Department of Public Health and Primary Care, ̽��ֱ�� of Cambridge, has previously used the forum to explore issues such as the impairment that can make it difficult for stroke survivors to maintain a job.

̽��ֱ��findings of the study, which looked at posts by 84 participants, including 49 stroke survivors and 33 caregivers, are published today in the journal BMJ Open. ̽��ֱ��Stroke Association gave the researchers permission to analyse the results, and to prevent identification of individuals, the team did not use verbatim comments.

Among the reasons cited by the forum users, side effects were a major factor in decisions to stop taking medication. Several contributors had experienced negative side effects and as a result had stopped taking the medication, sometimes in consultation with their GP and other times unilaterally. Others reported that they, or the person they were caring for, had stopped taking the medication after reading negative stories in the press about side effects.

Other users expressed concerns over the medication they were offered. There were conflicting views about the efficacy of the medications – some contributors believed they were very important, while others believed that their risk could be managed by lifestyle changes alone.

Contributors also reported mixed views of healthcare professionals – some felt confident in their doctor’s decision, while others questioned their decisions, some even questioning their motivation for prescribing particular drugs.

“These findings have highlighted the need for an open, honest dialogue between patients and/or their carers, and healthcare professionals,” says Dr De Simoni. “Doctors need to listen to these concerns, discuss the benefits and drawbacks of taking the medication, and be willing to support a patient’s informed decision to refuse medications.”

However, perceptions did not present the only barriers to adherence: there were often practical considerations. Drugs were sometimes too large and difficult to swallow, or a drug regime was too burdensome. ̽��ֱ��complexities of the drug regimens sometimes meant having to develop routines and strategies to ensure patients kept to them. One survivor described having to pay for the medications by credit card as she was unable to work and had no money or benefits coming in.

“By analysing people’s views as expressed in online forums, where they are more open and less guarded, we’ve seen some valuable insights into why some stroke survivors have difficulty adhering to their medication,” says PhD candidate and first author James Jamison from the Department of Public Health and Primary Care at Cambridge.

“Challenging negative beliefs about medication and adopting practices that make routines for taking medication simpler, particularly for those patients who have suffered disability as a result of stroke, should increase adherence and ultimately improve health outcomes.”

̽��ֱ��research was supported by the National Institute of Health Research, the Stroke Association and the British Heart Foundation.

For more information about statins, visit NHS Choices.

Reference
Jamison, J et al. Barriers and facilitators to adherence to secondary stroke prevention medications after stroke: Analysis of survivors’ and caregivers’ views from an online stroke forum. BMJ Open; 19 July 2017; DOI: 10.17863/CAM.10458

Negative media coverage of the side effects associated with taking statins, and patients’ own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially life-saving drugs, according to research published today.

These findings have highlighted the need for an open, honest dialogue between patients and/or their carers, and healthcare professionals

Anna De Simoni

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Medications

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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