Background Stroke is a serious condition that can have significant impact on an individual’s health and is a significant burden on public health and public finances. Secondary preventive drug treatment after stroke is important for decreasing the risk of recurrent strokes. Non-adherence to drug treatment hampers the treatment effect, especially in long-term preventive treatments. The aim of this thesis was to study the use of secondary preventive drugs after stroke among Swedish stroke patients in terms of inequalities in implementation in clinical practice and patient adherence to treatment over time. Methods Riks-Stroke, the Swedish stroke register, was used to sample stroke patients and as a source of information on background characteristics and medical and health care-related information including information on prescribed preventive drugs. The patients that were included had a stroke between 2004 and 2012. Individual patient data on prescriptions filled in Swedish pharmacies were retrieved from the Swedish Prescribed Drug Register and used to estimate patient adherence to drug treatment. Data on education, income, and country of birth were included from the LISA database at Statistics Sweden. A questionnaire survey was used to collect information about patients’ perceptions about stroke, beliefs about medicines, and self-reported adherence. Results Results showed that a larger proportion of men than women were prescribed statins and warfarin after stroke. There was also a social stratification in the prescribing of statins. Patients with higher income and a higher level of education were more likely to be prescribed a statin compared to patients with low income and low level of education. Statins were also more often prescribed to patients born in Nordic countries, Europe, or outside of Europe compared to patients born in Sweden. Primary non-adherence (not continuing treatment at all within 4 months of discharge from hospital) was low for preventive drug treatment after stroke. Data on filled prescriptions, however, indicated that the proportion of patients who continued to use the drugs declined during the first 2 years after stroke. For most drugs, refill adherence in drug treatment was associated with female sex, good self-rated health, and living in institutions and (for antihypertensive drugs and statins) having used the drug before the stroke. For statins and warfarin, a first-ever stroke was also associated with continuous drug use. Self-reported adherence 3 months after stroke also showed associations with patients’ personal beliefs about medicines; non-adherent patients scored higher on negative beliefs and lower on positive beliefs about medicines. Conclusion Inequalities between men and women and between different socioeconomic groups were found in the prescribing of secondary preventive drugs after stroke. Only a small proportion of Swedish stroke patients did not continue treatment after discharge from hospital, but the proportion of non-adherent patients increased over time. Poor adherence to preventive drug treatment after stroke is a public health problem, and improving adherence to drug treatment requires consideration of patients’ personal beliefs and perceptions about drugs.

<p><b>Background/ Objective:</b> In our current healthcare system, information seekers have a bulk of the responsibility to initiate conversations about medications. Although older adults report the need for more information about their medications, many do not accept offers to receive more information from pharmacists during the dispensing of prescription medications. Very little previous work focuses on how older adults make decisions about seeking and avoiding information about medicines, or how these decisions impact medication outcomes. Therefore, the specific aims of this study were to: 1) describe older adults’ attitudes about medication information seeking and the relationships between those attitudes and medication information management behaviors and 2) characterize the relationship between medication information management behaviors (MIMB), medication knowledge, medication beliefs, and attitudes towards medication information seeking. </p><p><b>Methods:</b> Older adults prescribed a new, chronic medication were recruited from a specialty geriatric clinic to participate in interviews that occurred either in-person or over the phone. Participates were randomized 1:1 to usual care or to patient-prompted medication counseling (PPMC). Participants in the PPMC group agreed to ask a pharmacist questions about their new medication at their next medication refill and received a brief education. A survey instrument based on the Theory of Motivated Information Management (TMIM) was adapted from past studies to assess participants’ attitudes about information seeking. Participants were asked to report their information seeking and avoidance over the previous six-months prior to the study and at baseline and month one. Open-ended questions from a national medication safety campaign were utilized to assess medication knowledge. A rubric was developed to score participants’ answers as incorrect knowledge, no knowledge, incomplete knowledge, or complete knowledge and used by two community pharmacists to determine patient medication knowledge (PMK) scores. Structural equation modeling was utilized to identify predictors of MIMB, and hierarchical and logistic regression were used to determine the relationship between MIMB and medication outcomes. </p><p><b>Results: </b>A total of 132 participants completed baseline surveys, and 126 participants completed the month one surveys. Overall, a structural model based on the TMIM met the a priori criteria for good fit (Bollen-Stine bootstrap=0.269). Participants’ positive outcomes assessments, negative outcomes assessments were direct, positive predictors of information seeking and direct, negative predictors of information avoidance. After controlling for baseline medication knowledge, the effect of the intervention, and information seeking there were statistically significant differences in medication knowledge between those participants that sought information from a pharmacist during refill dispensing and those who did not (B=0.259, p<0.001). Of those that sought information from a pharmacist, 70% gained information from baseline to month one, while 36.9% of those that did not seek information from a pharmacist gained information baseline to month. There were no differences in medication beliefs between those that sought information from a pharmacist and those that did not.</p><p><b>Discussion/ Conclusion:</b> Patient knowledge deficits continue well beyond the initial dispensing of a medication, and older adults are also at risk for knowledge loss over the course of prescription use. Receiving additional information from a pharmacist at the time of medication refill may be protective against this information loss, and even increase the change of gaining medication knowledge over time. However, medication counseling in its current form is likely not sufficient to alter older adults’ beliefs about medications. Only one pharmacist initiated a conversation with a participant at medication refill indicating that those participants who want additional information about their medications after the initial dispensing may have to initiate the conversation with a pharmacist.</p>