DRUG UTILIZATION AND OUTCOMES RESEARCH IN SINGAPORE STROKE PATIENTS

Abstract

Stroke is a devastating and debilitating disease. Although clinical practice guidelines have been developed in stroke, merely introducing them does not ensure adherence to recommended pharmacotherapy or improvement of outcomes. Studies are important to evaluate the relationship between recommended and real-world practice, and examine how drug utilization may influence outcomes. Among incident stroke patients in Singapore, use of thrombolytic therapy and secondary stroke preventive medications were observed to be largely in-line with guidelines, and associated with better outcomes. However, drug adherence was sub-optimal after hospital discharge, and this was associated with increased risk of stroke recurrence and mortality. Based on results from our systematic review and meta-analysis indicating the beneficial effects of selective serotonin reuptake inhibitors for stroke recovery, a prospective cohort study was conducted in stroke patients undergoing rehabilitation in a community hospital. Overall, this thesis demonstrated that stroke care in Singapore is evidence-based, but with room for improvement.