Abstract WP187: Predictors of Medication Adherence Prior to Hospitalization in a Multi-ethnic Cohort of First Stroke Survivors

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Abstract

Poor medication adherence is associated with poor health outcomes and elevated health care costs. Although studies have examined predictors of medication adherence after stroke, few have assessed factors associated with medication adherence prior to the stroke. We hypothesized that socioeconomic vulnerability and poor health behaviors would be important risk factors for low medication adherence prior to stroke hospitalization. Data for this study came from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial, a behavioral intervention to reduce vascular risk in a multi-ethnic group of mild/moderate stroke/TIA patients. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale and categorized as “low” (scores 3-8) or “medium/high” (scores 0-2). Chi-square tests were used to identify factors significantly associated with low adherence, which were then included in multivariable logistic regression models to examine their independent association with adherence, among those with no stroke/TIA history. Of the 309 patients with no stroke/TIA history who were taking medication prior to hospitalization (66.6% of the sample), 47.6% reported low medication adherence. Factors independently associated with increased odds of low adherence were being non-Hispanic black vs. non-Hispanic white (OR=2.8, 95% CI: 1.4-5.9), living with others vs. living alone (OR=3.1, 95% CI: 1.3-7.3 among those living with one non-spouse; OR=2.2, 95% CI: 1.2-4.3 among those living with more than one person), meeting criteria for depression (Center for Epidemiologic Studies - Depression score ≥ 16) (OR=2.0, 95% CI: 1.0-4.2), and drinking a greater number of drinks on one occasion in the past month (OR=1.4, 95% CI: 1.1-1.6). Older age was protective against low adherence (OR=0.5, 95% CI: 0.3-0.9 among those 65 years or older vs. less than 65). Targeted interventions to improve medication adherence among those at risk of stroke with other poor health behaviors, particularly among non-Hispanic black and younger individuals, may help reduce the risk of stroke in the first place.

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