Key result
Current adherence research largely excludes stroke survivors with severe disabilities who depend on caregivers, necessitating new studies that address both patient and caregiver non-adherence factors.
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Highlights the lack of evidence regarding medication adherence in stroke survivors dependent on caregivers and proposes a framework for future research.
In England >15 million people have a long-term condition and there are >5.4 million caregivers. Caregivers provide unpaid care by looking after an ill, older, or disabled family member, friend, or partner. The care provided includes aspects of medicine taking, making caregivers important stakeholders in patients’ adherence to prescribed treatments. We argue that there is a lack of evidence on factors affecting adherence to medications in patients with long-term conditions who are relying on others for medicine taking while living in the community. These patients and their caregivers are often excluded from adherence studies. Clinicians treating non-adherence in these patients therefore lack evidence on which to base their practice. To illustrate this, we have focused on survivors of stroke as an exemplar of other conditions. We propose a framework of research questions to address this knowledge gap, based on the theory of intentional and non-intentional non-adherence. We believe this framework could be applied to other patient populations who are dependent on others for medicine taking, for example, older patients with physical or cognitive impairments suffering from hypertension, type 2 diabetes, and other cardiovascular diseases, or patients suffering from severe psychiatric disorders/neurodegenerative diseases. Stroke recurrence is associated with higher disability and mortality than first-time stroke, and accounts for one-third of all events. Secondary prevention medicines can reduce risk of recurrence by three-quarters,1 making medicine taking an important daily activity in this patient group. Adherence studies have so far concentrated on those survivors of stroke who are responsible for their own medicine taking. They have revealed that absence of concerns about medications, knowledge of side effects, clear understanding of the consequences of non-adherence, and good routines of taking medications minimise non-adherence.2 Interventions aimed at these factors have indeed shown promising results.3 A recent systematic review of trials to improve …
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Simoni et al. (2015) conducted a review in Stroke. Caregiver dependence for medication administration was evaluated. Current adherence research largely excludes stroke survivors with severe disabilities who depend on caregivers, necessitating new studies that address both patient and caregiver non-adherence factors.
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