This article is more than 5 years old. Information may no longer be current.
Pharmacist-based activities may improve adherence to dabigatran
Click Here to Manage Email Alerts
In a study of patients with atrial fibrillation who filled prescriptions for dabigatran at Veterans Health Administration sites, medication adherence varied. However, pharmacist-led monitoring and appropriate patient selection were associated with greater adherence.
Researchers conducted a mixed-methods study to assess site-level variation in adherence to dabigatran (Pradaxa, Boehringer Ingelheim), which is approved for prevention of stroke and systemic embolism in patients with nonvalvular AF, and to identify site-level practices associated with greater adherence.
The researchers reviewed retrospective quantitative data from 67 Veterans Health Administration sites covering 4,863 patients filling dabigatran prescriptions for nonvalvular AF from 2010 to 2012. They also conducted a qualitative inquiry of 47 pharmacists at 41 sites.
The primary outcome was adherence to dabigatran, defined by proportion of days covered of 80% or more.
The median proportion of patients adherent to dabigatran was 74%.
When the researchers performed multivariable adjustment, they found that dabigatran adherence across sites varied (median OR = 1.57).
Across participating sites, 31 conducted appropriate patient selection, 30 provided pharmacist-led education and 28 provided pharmacist-led monitoring.
Greater adherence was observed at sites that conducted appropriate patient selection compared with those that did not (75% vs. 69%), those providing pharmacist-led education (76% vs. 66%) and those providing pharmacist-led monitoring (77% vs. 65%).
After multivariable adjustment, appropriate patient selection (RR = 1.14; 95% CI, 1.05-1.25) and pharmacist-led monitoring (RR = 1.25; 95% CI, 1.11-1.41) were associated with better patient adherence, but pharmacist-led education was not (RR = 0.94; 95% CI, 0.83-1.06).
Longer duration of monitoring improved adherence (RR for 6 months = 1.23; 95% CI, 1.1-1.37; RR for more than 12 months = 1.41; 95% CI, 1.23-1.61), as did providing more intensive care to nonadherent patients in conjunction with their clinician (RR = 1.31; 95% CI, 1.16-1.47).
The researchers noted that adherence outcomes did not differ between sites which were involved with anticoagulation clinics and those which were not, and between different modes of contacting patients.
“Our results highlight the importance of selecting patients and monitoring strategies to translate the efficacy of [target-specific oral anticoagulants] in randomized trials to clinical practice,” Supriya Shore, MD, from Emory University School of Medicine, and colleagues wrote. – by Erik Swain
Disclosure: One researcher reports consulting for Medtronic, Precision Health Economics and St. Jude Medical, and receiving a Gilead Sciences Cardiovascular Research Scholars Program Award.
Click Here to Manage Email Alerts