Chronic Disease Management to Enhance Medication Adherence Trajectories in Long-Term Survivors of Stroke: A Population-Based Cohort Study
Dalli, Lachlan L., Kilkenny, Monique F., Olaiya, Muideen, Ung, David, Kim, Joosup, Churilov, Leonid, Cadilhac, Dominique A., Sundararajan, Vijaya, Thrift, Amanda G., Nelson, Mark R., Lannin, Natasha A., Barnden, Rebecca, Srikanth, Velandai, and Andrew, Nadine E. (2025) Chronic Disease Management to Enhance Medication Adherence Trajectories in Long-Term Survivors of Stroke: A Population-Based Cohort Study. Pharmacoepidemiology and Drug Safety, 34 (5). e70148.
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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.
| Item ID: | 94336 |
|---|---|
| Item Type: | Article (Research - C1) |
| ISSN: | 1099-1557 |
| Keywords: | data linkage, medication adherence, pharmacoepidemiology, primary care, stroke |
| Copyright Information: | © 2025 The Author(s). Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
| Date Deposited: | 12 Nov 2026 07:01 |
| FoR Codes: | 42 HEALTH SCIENCES > 4203 Health services and systems > 420304 General practice @ 50% 42 HEALTH SCIENCES > 4206 Public health > 420605 Preventative health care @ 50% |
| SEO Codes: | 20 HEALTH > 2003 Provision of health and support services > 200303 Health surveillance @ 50% 20 HEALTH > 2001 Clinical health > 200102 Efficacy of medications @ 50% |
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