IntroductionMedications cannot exert their effect if not taken as prescribed by patients. Our objective was to summarise the observational evidence on adherence to oral anticoagulants (OACs) among patients with atrial fibrillation (AF).MethodsIn March 2019, we systematically searched PubMed/Medline, Embase, CINAHL and PsycINFO (from inception) for observational studies measuring adherence, its determinants and impacts in patients with AF. Mean adherence measures and corresponding proportions of adherent patients were pooled using random effects models. Factors shown to be independently associated with adherence were extracted as well as the clinical and economic outcomes of adherence.ResultsWe included 30 studies. Pooled mean adherence scores of over half a million patients with AF 6 months and 1 year after therapy initiation were 77 (95% CI: 74–79) and 74 (68–79) out of 100, respectively. Drug-specific pooled mean adherence score at 6 months and 1 year were as follows: rivaroxaban: 78 (73–84) and 77 (69–86); apixaban: 77 (75–79) and 82 (74–89); dabigatran: 74 (69–79) and 75 (68–82), respectively. There was inadequate information on warfarin for inclusion in meta-analysis.Factors associated with increased adherence included: older age, higher stroke risk, once-daily regimen, history of hypertension, diabetes or stroke, concomitant cardiovascular medications, living in rural areas and being an experienced OAC user. Non-adherent patients were more likely to experience stroke and death, and incurred higher medical costs compared with patients with poor adherence.ConclusionsOur findings show that up to 30% of patients with AF are non-adherent, suggesting an important therapeutic challenge in this patient population.

Proton pump inhibitors (PPIs) are acid-suppressant drugs that are widely prescribed for a number of gastrointestinal (GI) indications. In 2015, PPIs accounted for Can$253.3 million in public drug program spending in Canada, and were one of the top ten drug classes with the highest spending. 1 Furthermore, pantoprazole was found to be the fifth most common drug prescribed in Canada, with more than 11 million prescriptions dispensed in 2012. 2 With pantoprazole's high prevalence of use, there is a growing concern in the appropriateness and duration of its use. A Canadian prospective study found that 30.7% of patients were inappropriately prescribed with PPIs, in relation to the Quebec guidelines. 3 In addition, a retrospective cross-sectional study conducted in British Columbia found that the proportion of PPI orders without a documented common evidence-based indication or broad evidencebased indication were 43.7% and 16.2%, respectively. 4 While PPIs are generally well-tolerated, the long-term safety profiles of PPIs This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractObjective: Long-term use of proton pump inhibitors (PPIs) has been associated with an increased risk of harm. There are few studies evaluating pharmacist-led PPI deprescribing interventions within a long-term care facility setting. The aim of this study was to describe the changes and influencing factors seen with a pharmacist-led PPI deprescribing intervention in two Fraser Health Authority long-term care facilities in British Columbia. Methods:This 4-month intervention involved lists of residents who had active PPI orders being handed out to physicians from two facilities. The pharmacist conducted weekly reviews of residents from Facility 1 and offered deprescribing recommendations. The number and methods of PPI deprescribing orders per facility were determined after the intervention.Results: Out of 58 residents from the two facilities, 30 (62.5%) had a deprescribing order. Facility 1 had 83.3% (20/24) of residents with a PPI deprescribing order, in contrast to 41.7% (10/24) from Facility 2. Overall, 80.0% of residents had successfully completed PPI deprescribing orders by the end of the study period. Conclusion: Clinical pharmacist intervention may increase the rate of initiation in PPI deprescribing orders within a long-term care facility setting. Factors that influence success include intervention timing, active collaboration, having residents under direct care, and clear documentation of PPI indications. K E Y W O R D S deprescribing, pharmacist, proton pump inhibitors [Correction added on 16 May 2019, after first online publication: The corresponding author's email address has been corrected.] | 113 TANDUN eT Al.are controversial, as they are often associated with an increased risk of Clostridium diffici...

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