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Monday 10 April 2017

Some stroke survivors disregard doctors' advice on medications

Some stroke survivors say they are disregarding general practitioners' (GP) advice on secondary prevention medications, such as statins, with some patients stopping their medication completely, according to a study of an online stroke forum led by Queen Mary University of London (QMUL).

The researchers say that GPs should make patients aware of multiple treatment options and the potential need for several changes in medication, and actively follow-up with their patients when providing advice or changing treatment due to side effects, such as aches and tiredness.

Three in 10 stroke survivors will go on to have a further stroke, which causes greater disability or even death. Secondary prevention medications, including antihypertensives, blood thinning and lipid lowering agents, such as statins, can reduce risk of stroke recurrence by up to 75 per cent. However, patients' persistence with these medications decreases over time because a minority of people experience side effects, which are mild in most cases.

The analysis, involving University of Cambridge and published in the journal Family Practice, was performed on the archives from TalkStroke, a UK online forum hosted by the Stroke Association. The forum is used by patients with stroke and their carers, and generated 21,596 posts during 2004-2011. 50 participants were found to discuss GP advice on prevention medications in 43 discussion threads.

The side effects of secondary prevention medications, and statins in particular, were found to cause anxiety and resentment in some patients, and their concerns were not always addressed by GPs. While most advice was followed, GP advice was sometimes disregarded when related to dealing with statin side effects. Some patients even stopped the medication after just one or two attempts by the GP to adjust statin treatment.

Lead Researcher and NIHR Academic Clinical Lecturer Dr Anna De Simoni from QMUL said: "I am a GP and these findings have changed my own practice when I start patients on statins and when they consult about side effects.

"Given the variety of cholesterol lowering treatments and possible approaches to manage statin intolerant patients, I was surprised to see that patients seemingly lost hope after only one or two contacts with their GPs, unaware that a better regimen may have been available or that their GP would have been able to carry out another change in medication.

"In my practice I am now advising patients that multiple treatment options are available, and several attempts may be required before a suitable treatment is found. It is also important to pro-actively invite them to seek help if side effects are experienced and don't improve."

The researchers say that advising patients to persist with statins side effects to prevent further strokes could result in the patient stopping the medication. Following up patients (even by telephone) after any change in treatment or advice could ensure issues are resolved.

The study found that forum participants did not make incorrect or misleading statements, but instead provided appropriate peer support, underlined the central role of GPs in managing medications, and their shared-decision making with clinicians was improved by online peer-to-peer discussions. The forum's 'super-users', who had a high number of connections with other participants, played an important role in this.

Considering the ease, low-cost and advantages of obtaining patient information from online fora, the researchers say that more attention could be paid into studying health issues using data from online communities. This could allow collection of data from participants who might not take part in traditional research studies and from a wider geographical location.

The study is limited in that the data are old (2004-2011), the identity of users could not be verified, the forum was moderated, and older patients might be under-represented.

Full text of study here:



only slightly confused said...

Excellent public service post. If you are experiencing trouble with your meds or feeling that they are not doing the job you have two sources of assistance...your gp or specialist and your pharmacist. Don't disregard your pharmacist. They have a wealth of information at their fingertips and can advise you of alternate methods of taking your meds, or indeed, an alternative to the meds themselves. Sometimes just changing the time of day or taking (or not taking) the meds with food or avoiding certain foods while taking this particular prescription...your pharmacist can make all the difference in your success.

Susan Kane said...

Important information can and must be relayed by Dr., and Pharmacist. Patients don't ask enough questions, and Dr. don't often relay necessary info.

As a migraine sufferer, I am 4X more likely to have a stroke. Fortunately, most Drs I have had were thorough. Recently was put on a statin, for reasons you included in this blog.

Such an excellent post, Jan.

Francisco Manuel Carrajola Oliveira said...

Um artigo bem interessante.
Um abra├žo e boa semana.

Dedais de Francisco e Idalisa

Conniecrafter said...

It is so important for Doctors to tell you everything you need to know, not just throw meds at you and not give you any explanation as to why they are giving it to you, and what can be the result if you don't take it, I have some doctors that are very good at explaining and others that just seem to want to get the visit over with so they can get on to the next patient and you leave feeling you don't really know what is going on.