Chronic Disease Management to Enhance Medication Adherence Trajectories in Long-Term Survivors of Stroke: A Population-Based Cohort Study

Abstract

Purpose: Although chronic disease management (CDM) has been reported to improve medication adherence after stroke or transient ischaemic attack (TIA), the impact on specific patterns of medication adherence is unclear. We aimed to evaluate the population effect of receiving a CDM claim on trajectories of medication adherence in long-term survivors of stroke/TIA. Methods: A cohort study was undertaken using observational data from PRECISE (42 Australian Stroke Clinical Registry hospitals [Victoria and Queensland; 2012–2015] linked with medication dispensing and primary care claims). Community-dwelling adults with ≥ 1 primary care visit were included. The exposure was a CDM claim (versus no claim) in primary care within 7–18 months post-stroke/TIA. Medication adherence (antihypertensive, antithrombotic, lipid-lowering) was assessed between 19 and 30 months post-stroke/TIA, using group-based trajectory models. Average treatment effects were estimated using multi-level logistic regression with inverse probability treatment weights. Results: Among 11 580 survivors of stroke/TIA (median age 70 years, 42% female; 45% with CDM claim), four distinct adherence patterns were identified: near-perfect adherence, high adherence, declining adherence, and non-use. After adjustment, having a CDM claim (vs no claim) promoted near-perfect adherence (odds ratio [OR]: 1.16 [95% CI 1.08–1.25]) for antithrombotic medications. Whereas, having a CDM claim (vs no CDM claim) promoted high adherence for antihypertensive (OR: 1.33 [95% CI 1.24–1.44]) or lipid-lowering (OR: 1.26 [95% CI 1.16–1.37]) medications. The odds of non-use were also reduced by 17%–23% in those with (vs without) a CDM claim. Conclusions: CDM claims were associated with favourable trajectories of medication adherence in long-term survivors of stroke/TIA.