There were no significant effects of organisational  interventions on lipid profile , HbA1c , medication adherence or recurrent cardiovascular events .
Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes .
The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors .
BACKGROUND People with stroke or transient ischaemic attack ( TIA ) are at increased risk of future stroke and other cardiovascular events .
Evidence -based strategies for secondary stroke prevention have been established .
However , the implementation of prevention strategies could be improved .
OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control , including patient adherence to prescribed medications , and the occurrence of secondary cardiovascular events .
Improving Adherence to Secondary Stroke Prevention Strategies Through Motivational Interviewing: Randomized Controlled Trial
Background and Purpose — Stroke recurrence rates are high ( 20%–25 % ) and have not declined over past 3 decades . This study tested effectiveness of motivational interviewing ( MI ) for reducing stroke recurrence , measured by improving adherence to recommended medication and lifestyle changes compared with usual care . Methods — Single-blind , prospect i ve phase III r and omized controlled trial of 386 people with stroke assigned to either  MI treatment ( 4 sessions at 28 days , 3 , 6 , and 9 months post stroke ) or usual care ; with outcomes assessed at 28 days , 3 , 6 , 9 , and 12 months post stroke . Primary outcomes were change in systolic blood pressure and low-density lipoprotein cholesterol levels as indicators of adherence at 12 months . Secondary outcomes included self-reported adherence , new stroke , or coronary heart disease events ( both fatal and nonfatal ) ; quality of life ( Short Form-36 ) ; and mood ( Hospital Anxiety and Depression Scale ) . Results — MI did not significantly change measures of blood pressure ( mean difference in change , −0.2.35 [ 95 % confidence interval , −6.16 to 1.47 ] ) or cholesterol ( mean difference in change , −0.0.12 [ 95 % confidence interval , −0.30 to 0.06 ] ) . However , it had positive effects on self-reported medication adherence at 6 months ( 1.979 ; 95 % confidence interval , 0.98–3.98 ; P=0.0557 ) and 9 months ( 4.295 ; 95 % confidence interval , 1.56–11.84 ; P=0.0049 ) post stroke . Improvement across other measures was also observed , but the differences between MI and usual care groups were not statistically significant . Conclusions — MI improved self-reported medication adherence . All other effects were nonsignificant , though in the direction of a treatment effect . Further study is required to determine whether MI leads to improvement in other important areas of functioning ( eg , caregiver burden ) . Clinical Trial Registration — URL : http://www.anzctr.org.au . Unique identifier : ACTRN-12610000715077
There were no significant effects of organisational  interventions on lipid profile , HbA1c , medication adherence or recurrent cardiovascular events .
Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes .
The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors .
BACKGROUND People with stroke or transient ischaemic attack ( TIA ) are at increased risk of future stroke and other cardiovascular events .
Evidence -based strategies for secondary stroke prevention have been established .
However , the implementation of prevention strategies could be improved .
OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control , including patient adherence to prescribed medications , and the occurrence of secondary cardiovascular events .