Abstract
Background and purpose: Little is known about factors relating to initiation and discontinuation of antiplatelet
and anticoagulant therapies among stroke survivors in nursing homes.
Methods: In 6 states from 1992 to 1996, we followed up stroke survivors admitted to nursing
homes for at least 6 months; 9547 were not receiving any secondary stroke prevention
treatment at admission, whereas 6244 were receiving therapy. Factors relating to initiation
and discontinuation of drug therapy included resident factors (e.g., sociodemographics,
clinical factors) and facility factors (e.g., for profit, part of a chain). Generalized
estimating equations provided estimates of residents and facility characteristics
adjusting for the clustering effects owing to the correlation of residents living
within the same home.
Results: In all, 12% initiated drug therapy; 30.3% discontinued. Conditions known to increase
the risk of recurrent stroke (e.g., atrial fibrillation) were predictive of initiation.
Black residents (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.49–0.78) were
less likely than non-Hispanic white residents to initiate therapy. American Indian
(OR 1.16, 95% CI 0.80–1.68), black (OR 1.23, 95% CI 1.03–1.47), and Hispanic residents
(OR 1.30, 95% CI 0.79–2.13) tended to be more likely than non-Hispanic white residents
to discontinue therapy, with facility characteristics completely explaining the observed
associations.
Conclusions: In nursing homes, interventions to improve drug management of recurrent stroke are
needed and implementation should occur without regard to a patient’s skin color. Intervention
studies may have little success in the nursing home setting if the context in which
the care is given and financial/structural difficulties are not addressed in the implementation
of such interventions.
Keywords
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Article info
Publication history
Accepted:
June 16,
2004
Received:
April 16,
2004
Footnotes
☆Supported by a grant from the National Institutes on Aging (AG: #17957-01). Dr Hughes is currently being supported by a National Primary Care Career Scientist Award from the Research and Development Office, Northern Ireland. Dr Hughes was a Harkness Fellow in Healthcare Policy during 1998 and 1999.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2004.06.002
Copyright
© 2004 National Stroke Association. Published by Elsevier Inc. All rights reserved.
