Impact of a Pluriprofessional Intervention to Improve Medication Adherence (Secondary Preventive Medication) in Patients After Ischemic Stroke

Impact of a Pluriprofessional Intervention to Improve Medication Adherence (Secondary Preventive Medication) in Patients After Ischemic Stroke (ADMED-AVC)

Medication adherence is a major factor to prevent vascular recurrence after a first ischemic stroke. Nevertheless, it is suboptimal and the implementation of specific interventions are needed to improve it.

A patient - centered and pluriprofessional structured intervention, targeting the medication, introduced at hospital discharge and continued at home (by regular telephone contact) could improve medication adherence one year after stroke.

This intervention would consist of semi structured interviews patient-pharmacist at different times during one year after stroke. The information about the therapeutic management of the patient will be shared between healthcare professionals : general practitioners (GP) and community pharmacists (CP), hospital clinical pharmacist (HCP) and physician (HPhys).

It will allow for decrease of the recurrent stroke and others cardiovascular complications based on a better adherence to preventive medication. Furthermore the decrease of the iatrogenic events and the improvement of the quality of life of patients may be also associated.

Inclusion Criteria:

• Aged ≥ 18 years
• Patient with ischemic stroke hospitalized in physical medicine and rehabilitation unit or neurovascular unit
• Return at home at the hospital discharge
• Medication including an antiplatelet drug or an oral anticoagulant with at least an antihypertensive drug and/or a lipid lowering agent (statin)
• Patient without either cognitive disorders or major psychiatric disorders
• Patient with a sufficient autonomy for the management of medication at home (score of Barthel > 30)

Exclusion Criteria:

• Patient ≤ 18 years
• Patient with important cognitive or psychiatric disorders
• Management of patient medication exclusively by the helper
• No usual pharmacy (or more than 2 usual pharmacies)
• Patient directed to an institution at the end of the hospitalization