Nurse-led intervention to improve knowledge of medications in survivors of stroke or transient ischemic attack: A cluster randomized controlled trial

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Abstract

Introduction: Limited evidence exists on effective interventions to improve knowledge of preventive medications in patients with chronic diseases, such as stroke. We investigated the effectiveness of a nurse-led intervention, where a component was to improve knowledge of prevention medications, in patients with stroke or transient ischemic attack (TIA). Methods: Prospective sub-study of the Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management, a randomized controlled trial of risk factor management. We recruited patients aged ≥18 years and hospitalized for stroke/TIA. The intervention comprised an individualized management program, involving nurse-led education, and management plan with medical specialist oversight. The outcome, participants' knowledge of secondary prevention medications at 12 months, was assessed using questionnaires. A score of ≥5 was considered as good knowledge. Effectiveness of the intervention on knowledge of medications was determined using logistic regression. Results: Between May 2014 and January 2015, 142 consecutive participants from the main trial were included in this sub-study, 64 to usual care and 78 to the intervention (median age 68.9 years, 68% males, and 79% ischemic stroke). In multivariable analyses, we found no significant difference between intervention groups in knowledge of medications. Factors independently associated with good knowledge (score ≥ 5) at 12 months included higher socioeconomic position (OR 4.79, 95% CI 1.76, 13.07), greater functional ability (OR 1.69, 95% CI 1.17, 2.45), being married/living with a partner (OR 3.12, 95% CI 1.10, 8.87), and using instructions on pill bottle/package as an administration aid (OR 4.82, 95% CI 1.76, 13.22). Being aged ≥65 years was associated with poorer knowledge of medications (OR 0.24, 95% CI 0.08, 0.71), while knowledge was worse among those taking three medications (OR 0.15, 95% CI 0.03, 0.66) or ≥4 medications (OR 0.09, 95% CI 0.02, 0.44), when compared to participants taking fewer (≤2) prevention medications. Conclusion: There was no evidence that the nurse-led intervention was effective for improving knowledge of secondary prevention medications in patients with stroke/TIA at 12 months. However, older patients and those taking more medications should be particularly targeted for more intensive education. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12688000166370).

Original languageEnglish
Article number205
Number of pages10
JournalFrontiers in Neurology
Volume7
Issue numberNov
DOIs
Publication statusPublished - 18 Nov 2016

Keywords

  • Nursing intervention
  • Patient medication knowledge
  • Randomized controlled trial
  • Secondary prevention
  • Stroke

Cite this

@article{01d631a5afe240acb62330c5eb5d65a7,
title = "Nurse-led intervention to improve knowledge of medications in survivors of stroke or transient ischemic attack: A cluster randomized controlled trial",
abstract = "Introduction: Limited evidence exists on effective interventions to improve knowledge of preventive medications in patients with chronic diseases, such as stroke. We investigated the effectiveness of a nurse-led intervention, where a component was to improve knowledge of prevention medications, in patients with stroke or transient ischemic attack (TIA). Methods: Prospective sub-study of the Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management, a randomized controlled trial of risk factor management. We recruited patients aged ≥18 years and hospitalized for stroke/TIA. The intervention comprised an individualized management program, involving nurse-led education, and management plan with medical specialist oversight. The outcome, participants' knowledge of secondary prevention medications at 12 months, was assessed using questionnaires. A score of ≥5 was considered as good knowledge. Effectiveness of the intervention on knowledge of medications was determined using logistic regression. Results: Between May 2014 and January 2015, 142 consecutive participants from the main trial were included in this sub-study, 64 to usual care and 78 to the intervention (median age 68.9 years, 68{\%} males, and 79{\%} ischemic stroke). In multivariable analyses, we found no significant difference between intervention groups in knowledge of medications. Factors independently associated with good knowledge (score ≥ 5) at 12 months included higher socioeconomic position (OR 4.79, 95{\%} CI 1.76, 13.07), greater functional ability (OR 1.69, 95{\%} CI 1.17, 2.45), being married/living with a partner (OR 3.12, 95{\%} CI 1.10, 8.87), and using instructions on pill bottle/package as an administration aid (OR 4.82, 95{\%} CI 1.76, 13.22). Being aged ≥65 years was associated with poorer knowledge of medications (OR 0.24, 95{\%} CI 0.08, 0.71), while knowledge was worse among those taking three medications (OR 0.15, 95{\%} CI 0.03, 0.66) or ≥4 medications (OR 0.09, 95{\%} CI 0.02, 0.44), when compared to participants taking fewer (≤2) prevention medications. Conclusion: There was no evidence that the nurse-led intervention was effective for improving knowledge of secondary prevention medications in patients with stroke/TIA at 12 months. However, older patients and those taking more medications should be particularly targeted for more intensive education. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12688000166370).",
keywords = "Nursing intervention, Patient medication knowledge, Randomized controlled trial, Secondary prevention, Stroke",
author = "Olaiya, {Muideen T.} and Cadilhac, {Dominique A.} and Joosup Kim and David Ung and Nelson, {Mark R.} and Srikanth, {Velandai K.} and Bladin, {Christopher F.} and Gerraty, {Richard P.} and Fitzgerald, {Sharyn M.} and Phan, {Thanh G.} and Judith Frayne and Thrift, {Amanda G.}",
year = "2016",
month = "11",
day = "18",
doi = "10.3389/fneur.2016.00205",
language = "English",
volume = "7",
journal = "Frontiers in Neurology",
issn = "1664-2295",
publisher = "Frontiers Media",
number = "Nov",

}

TY - JOUR

T1 - Nurse-led intervention to improve knowledge of medications in survivors of stroke or transient ischemic attack

T2 - A cluster randomized controlled trial

AU - Olaiya, Muideen T.

AU - Cadilhac, Dominique A.

AU - Kim, Joosup

AU - Ung, David

AU - Nelson, Mark R.

AU - Srikanth, Velandai K.

AU - Bladin, Christopher F.

AU - Gerraty, Richard P.

AU - Fitzgerald, Sharyn M.

AU - Phan, Thanh G.

AU - Frayne, Judith

AU - Thrift, Amanda G.

PY - 2016/11/18

Y1 - 2016/11/18

N2 - Introduction: Limited evidence exists on effective interventions to improve knowledge of preventive medications in patients with chronic diseases, such as stroke. We investigated the effectiveness of a nurse-led intervention, where a component was to improve knowledge of prevention medications, in patients with stroke or transient ischemic attack (TIA). Methods: Prospective sub-study of the Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management, a randomized controlled trial of risk factor management. We recruited patients aged ≥18 years and hospitalized for stroke/TIA. The intervention comprised an individualized management program, involving nurse-led education, and management plan with medical specialist oversight. The outcome, participants' knowledge of secondary prevention medications at 12 months, was assessed using questionnaires. A score of ≥5 was considered as good knowledge. Effectiveness of the intervention on knowledge of medications was determined using logistic regression. Results: Between May 2014 and January 2015, 142 consecutive participants from the main trial were included in this sub-study, 64 to usual care and 78 to the intervention (median age 68.9 years, 68% males, and 79% ischemic stroke). In multivariable analyses, we found no significant difference between intervention groups in knowledge of medications. Factors independently associated with good knowledge (score ≥ 5) at 12 months included higher socioeconomic position (OR 4.79, 95% CI 1.76, 13.07), greater functional ability (OR 1.69, 95% CI 1.17, 2.45), being married/living with a partner (OR 3.12, 95% CI 1.10, 8.87), and using instructions on pill bottle/package as an administration aid (OR 4.82, 95% CI 1.76, 13.22). Being aged ≥65 years was associated with poorer knowledge of medications (OR 0.24, 95% CI 0.08, 0.71), while knowledge was worse among those taking three medications (OR 0.15, 95% CI 0.03, 0.66) or ≥4 medications (OR 0.09, 95% CI 0.02, 0.44), when compared to participants taking fewer (≤2) prevention medications. Conclusion: There was no evidence that the nurse-led intervention was effective for improving knowledge of secondary prevention medications in patients with stroke/TIA at 12 months. However, older patients and those taking more medications should be particularly targeted for more intensive education. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12688000166370).

AB - Introduction: Limited evidence exists on effective interventions to improve knowledge of preventive medications in patients with chronic diseases, such as stroke. We investigated the effectiveness of a nurse-led intervention, where a component was to improve knowledge of prevention medications, in patients with stroke or transient ischemic attack (TIA). Methods: Prospective sub-study of the Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management, a randomized controlled trial of risk factor management. We recruited patients aged ≥18 years and hospitalized for stroke/TIA. The intervention comprised an individualized management program, involving nurse-led education, and management plan with medical specialist oversight. The outcome, participants' knowledge of secondary prevention medications at 12 months, was assessed using questionnaires. A score of ≥5 was considered as good knowledge. Effectiveness of the intervention on knowledge of medications was determined using logistic regression. Results: Between May 2014 and January 2015, 142 consecutive participants from the main trial were included in this sub-study, 64 to usual care and 78 to the intervention (median age 68.9 years, 68% males, and 79% ischemic stroke). In multivariable analyses, we found no significant difference between intervention groups in knowledge of medications. Factors independently associated with good knowledge (score ≥ 5) at 12 months included higher socioeconomic position (OR 4.79, 95% CI 1.76, 13.07), greater functional ability (OR 1.69, 95% CI 1.17, 2.45), being married/living with a partner (OR 3.12, 95% CI 1.10, 8.87), and using instructions on pill bottle/package as an administration aid (OR 4.82, 95% CI 1.76, 13.22). Being aged ≥65 years was associated with poorer knowledge of medications (OR 0.24, 95% CI 0.08, 0.71), while knowledge was worse among those taking three medications (OR 0.15, 95% CI 0.03, 0.66) or ≥4 medications (OR 0.09, 95% CI 0.02, 0.44), when compared to participants taking fewer (≤2) prevention medications. Conclusion: There was no evidence that the nurse-led intervention was effective for improving knowledge of secondary prevention medications in patients with stroke/TIA at 12 months. However, older patients and those taking more medications should be particularly targeted for more intensive education. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12688000166370).

KW - Nursing intervention

KW - Patient medication knowledge

KW - Randomized controlled trial

KW - Secondary prevention

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85006141292&partnerID=8YFLogxK

U2 - 10.3389/fneur.2016.00205

DO - 10.3389/fneur.2016.00205

M3 - Article

VL - 7

JO - Frontiers in Neurology

JF - Frontiers in Neurology

SN - 1664-2295

IS - Nov

M1 - 205

ER -