Background and Aims

Australian primary care physicians receive financial incentives for providing chronic disease management (CDM) plans. It is unclear if these CDM plans improve medication adherence following stroke or transient ischaemic attack (TIA).

Aims: To determine whether use of a CDM plan post-stroke/TIA improves preventive medication adherence.

Methods

Retrospective cohort study of Victorian and Queensland survivors of stroke/TIA from the Australian Stroke Clinical Registry (Jan 2012-Jun 2016). We linked our cohort with administrative claims data and undertook analyses to emulate a randomised controlled trial. Use of CDM plans during the exposure period (6-18 months post-admission) was assessed using Medicare claims. The proportion of days covered (PDC) by each medication (antihypertensive, lipid-lowering, non-aspirin antithrombotic) during outcome assessment (19-30 months post-admission) was determined based on dispensing records from the Pharmaceutical Benefits Scheme. The average treatment effect of CDM plans on being adherent (PDC ≥80% was determined using propensity-score adjusted logistic regression.

Results

Among 14,465 survivors of stroke/TIA (median age 70 years; 42% female), 44% received a CDM plan during the exposure period (median age 73 years; 45% female). During the 1-year outcome period, the median PDC was 80% for antihypertensive, 81% for lipid-lowering, and 62% for non-aspirin antithrombotic medications. In propensity-score adjusted analyses, treatment with CDM plan was associated with being adherent to antihypertensive (odds ratio [OR]: 1.13; 95% CI: 1.05-1.22), lipid-lowering (OR: 1.21; 95% CI: 1.13-1.30), and non-aspirin antithrombotic medications (OR: 1.14; 95% CI: 1.06-1.23).

Conclusions

Use of CDM plans is associated with improved long-term adherence to secondary prevention medications following stroke/TIA.

Background and Aims

Lipid-lowering medications (LLMs) are recommended for secondary prevention of stroke. Little is known about the association between their ongoing use post-discharge and outcomes. We investigated the use and adherence to LLMs within the first 90 days post-discharge for ischaemic stroke and associated 12-month outcomes.

Methods

Retrospective cohort study of 90-day survivors of ischaemic stroke from hospitals (n=45) in two Australian states participating in the Australian Stroke Clinical Registry (2012-2016). Person-level data were linked with Pharmaceutical Benefits Scheme (PBS), hospital and death datasets. LLM use within 90 days post-discharge was determined from PBS dispensing records. Among users, adherence was assessed using the proportion of days covered (PDC: <80% vs. ≥80%) within 90 days post-discharge. Outcomes during the subsequent year (91-455 days) included all-cause mortality and hospital readmissions (cardiovascular disease, all-cause). Associations between use/adherence and outcomes were determined using propensity score adjusted-multivariable Cox regression models.

Results

Of 11,217 eligible patients (median age 72 years, 42% female), 9,294 (83%) used LLMs within 90 days post-discharge, including 5,938 (64%) with PDC ≥80%. Compared to users, non-users, had greater rates of mortality [hazard ratio (HR) 2.35, 95% CI 1.89-2.93] or all-cause readmissions (HR 1.16, CI 1.09-1.22). Among users, those with PDC <80% had greater rates of mortality (HR 1.31, CI 1.14-1.51) or all-cause readmissions (HR 1.05, CI 1.00-1.09) than those with PDC ≥80%. There were no associations between use/adherence and cardiovascular disease readmissions.

Conclusions

Use and greater adherence to LLMs (90-days) for ischaemic stroke is associated with reduced all-cause mortality and readmissions.

Background and Aims

It is unclear whether treatment with lipid-lowering medications (LLMs) affects health-related quality of life (HRQoL) after stroke. We evaluated the association between 90-day use and adherence to LLMs after hospital discharge for ischaemic stroke and HRQoL.

Methods

Retrospective cohort study of 90-day survivors of ischaemic stroke admitted to hospitals in Victoria and Queensland participating in the Australian Stroke Clinical Registry (2012-2016). Use and adherence to LLMs were determined through linkage of patient-level data with the Pharmaceutical Benefits Scheme. Adherence to LLMs in the first 90 days post-discharge was calculated as the proportion of days covered (PDC: <80% vs. ≥80% [greater adherence]). The EQ-5D-3L questionnaire was administered to registrants between 90-180 days from hospital admission date to assess self-reported HRQoL overall and across five health domains. Cross-sectional associations between use/adherence and HRQoL outcomes were determined using multivariable regression models.

Results

Of 6,780 eligible registrants (median age 72 years, 42% female), 5,816 (86%) used LLMs in 90 days post-discharge, including 3,838 (66%) with PDC ≥80%. Compared to users, non-users were at significantly greater odds of reporting problems in each health domain: mobility (odds ratio 1.40), self-care (1.81), usual activities (1.26), pain/discomfort (1.19), and anxiety/depression (1.39). Non-use of LLMs was also associated with poorer overall HRQoL (-5.00, 95% CI -7.27, -2.73). Among users, having a PDC <80% was associated with reporting problems in each health domain and poorer overall HRQoL.

Conclusions

Use and greater adherence to LLMs post-discharge for ischaemic stroke is associated with better HRQoL outcomes.

Background and Aims

General practitioners use chronic disease management plans (CDMPs) to manage the healthcare of people with chronic diseases who require a structured approach. We aimed to determine whether treatment with CDM plans reduces all-cause readmission costs in patients with stroke or TIA.

Methods

Secondary data linkage analyses were conducted using the cohort of the cluster-randomised trial (STAND FIRM). Participants aged ≥18 years admitted for stroke or TIA were recruited from four hospitals in Melbourne. Person-level data from the trial were linked to datasets on CDM plan use and hospitalisations. Costs of readmissions from index discharge to two years were estimated using information from the 2015 National Hospital Costs Data Collection in AUD. The cost of same-day and multiday readmissions were estimated applying the average cost of same day separations and average cost per day for overnight separations, respectively. Median regression was used to compare readmission costs between those who used CDMPs for two years and those who did not.

Results

Among 563 participants recruited (median age 70 years, 64% male), 323 used CDMPs and 422 had at least one all-cause readmission within two years after hospital discharge. The median length of stay was three days (interquartile range 2-11 days). The median cost of readmissions was $4,358 (interquartile range $2,638-$19,268). The between-group difference was not significant (adjusted for age, sex and comorbidity profile ß=$-1,004, 95% CI $-4,399; $2,391, p value 0.56).

Conclusions

Treatment with CDMPs was not significantly associated with reduced readmission costs in patients with stroke or TIA.