Sunday, February 6, 2011

Stroke Patients Stop Taking Medicine

A study published in the Archives of Neurology reported that a quarter of patients who have a stroke stopped taking their medication within 3 months of hospital discharge.  These medications were meant to be prevention for future strokes.  With 180,000 recurrent strokes occurring in the U.S. each year, that is an astonishing number of patients who stop their prevention meds.  Also,  the recurrence rate is the highest during this 3 month period so these patients are at risk of losing more brain function.  Twenty percent of the patients were taking half of the prescribed medication and 3.5% had stopped all of the meds.

We need to understand why patients who have suffered a stroke would put themselves at risk for a 2nd event.  The reasons for going off medication were multiple.  And some of them are no surprise.
  • Not understanding the importance of the medication
  • Not understanding how to take the medication or to refill prescriptions
  • Increasing age and confusion
  • Financial hardship
  • Too many confusing medications
  • Lack of health insurance
This study points to the flaws in our medical system.  We are so good at heroic life saving interventions and then sending patients out of the hospital with expensive medication but that is where our "goodness" stops.  If a patient is lucky enough to have an intact family, health insurance, and a good network of out-patient doctors,  they might do well.  If any of those factors are missing, the likelihood for another stroke and re-hospitalization is high...and we start all over.

To really impact health we have to stop the silos of treatment.  It is equally important that time be spent explaining the medication and what it is for, as it is to administer clot busting drugs.  An evaluation of the patient's living situation and ability to understand and take medication is as important as those weeks of expensive hospitalization that got them to a  point where they could go home.  And if the patient has few resources, spending up to $84.00 a month for Plavix and more for a Statin  is impossible.  Helping them get discount medication is essential if they are going to take it long-term.

Before the patient leaves the hospital, we need to understand all of these dynamics.

This study shows us how far we need to go to be a truly great health care country.

19 comments:

BrainDame said...

The is so much we could do in this area with "nanomedicine" or through wireless technology BUT as there is currently no reimbursement for this, none of the primary care doctors I know want to have anything to do with it!
What a shame-no reward for innovation

Toni Brayer, MD said...

BranDame: you will have to tell me more. Would love to know about this.

Toni Brayer, MD said...

Oops..I know you are BrainDame, not BranDame

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