Adherence and outcomes of patients treated with dabigatran: Pharmacist-managed anticoagulation clinic versus usual care

Lee, Pei-Yu; Han, Sora; Miyahara, Randell K.

doi:10.2146/ajhp120634

Cited by 22 publications

(38 citation statements)

References 15 publications

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“…10 Another study found that anticoagulant clinic patients were more likely to have medication possession ratio (MPR) values of Z80% (considered to be good adherence) on dabigatran at the end of a three-month period than the usual care group. 11 In spite of existing dabigatran research, adherence for this new anticoagulant agent varies among studies and remains sparsely documented.…”

Section: Medication Adherencementioning

confidence: 99%

The Use of Electronic Personal Health Records to Improve Medication Adherence and Patient Engagement: A Randomized Study of Non-valvular Atrial Fibrillation Patients

Chen¹,

Roebuck²,

Sami³

et al. 2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. Embolic stroke is a major complication of atrial fibrillation (AF) that frequently results in disability or death. The administration of oral anticoagulation can reduce stroke risk in AF patients; however, medication non-adherence can eliminate this benefit. To date, reported patient adherence rates to oral anticoagulation regimens vary. The objective of the current study was to examine the impact of medication-specific education delivered via a personal health record (PHR) system on medication adherence. A randomized, prospective study was conducted from February 2014 to June 2014 at Parkview Health, a not-for-profit, community-based health care clinic that serves a northeastern Indiana population of more than 820,000. AF patients receiving dabigatran (Pradaxa s ; Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany) to prevent stroke participated in this study. The study participants were predominantly Caucasian males over 65 years of age who were educated, insured, and living above the poverty level. Patients were allowed to view online, download, and transmit health information via a PHR. The intervention group received PHR training and dabigatran education via the PHR. The control group received standard care and PHR access without training. A longitudinal survey pertaining to medication knowledge, medication adherence, and patient engagement was administered at baseline and at the end of the study. Medication-dispensing data collected from pharmacy refill prescriptions were used for calculating the medication possession ratio (MPR). Ninety patients were included in this study, and were randomly assigned to either the intervention group (n ¼ 46) or the control group (n ¼ 44). All participants completed the baseline survey, and 95.6% of patients finished the follow-up survey. The mean score for knowledge increased significantly in the intervention group (from 3.77 to 4.23, p ¼ 0.005), but not in the control group (from 3.70 to 3.95, p ¼ 0.72). The MPR was significantly higher in the intervention group (97.47% vs. 87.67%, p ¼ 0.001). Both groups had similar levels of improvement in Patient Activation Measure scores (from 63.0 to 65.8, p ¼ 0.078 vs. from 63.1 to 63.6, p ¼ 0.814). Patients who used the PHR achieved greater medication knowledge, resulting in improved medication adherence. To our knowledge, no published randomized trial has reported on the use of PHRs to improve medication adherence and knowledge. This study is the first to demonstrate a positive impact on anticoagulation adherence with PHR use.

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Section: Medication Adherencementioning

confidence: 99%

The Use of Electronic Personal Health Records to Improve Medication Adherence and Patient Engagement: A Randomized Study of Non-valvular Atrial Fibrillation Patients

Chen¹,

Roebuck²,

Sami³

et al. 2017

J Innov Cardiac Rhythm Manage

View full text Add to dashboard Cite

show abstract

“…The study duration ranged between 3 ( Lee et al, 2013) and 32 (Forslund et al, 2016) months and the data collection method involved patients or national databases. The nine prospective cohort studies were conducted in seven (countries (the UK, the US, Denmark, New Zealand, China, Taiwan, and Germany).…”

Section: Resultsmentioning

confidence: 99%

“…The study duration ranged from 10 ( Thorne et al, 2014) to 23 (Gorst-Rasmussen et al, 2015) months and the sample sizes ranged from 150 (Hu et al, 2015) to 27,514 (Martinez et al, 2016) subjects. The data collection method involved electronic medical record reviews (Donaldson and Norbeck, 2013;Lee et al, 2013;Cutler et al, 2014;Ho et al, 2014;Monteagudo et al, 2015;Martinez et al, 2016), electronic national database searches Larsen et al, 2013;Graham et al, 2014;Beyer-Westendorf et al, 2015;Chang et al, 2015;Gorst-Rasmussen et al, 2015;Hu et al, 2015;Chan et al, 2016;Forslund et al, 2016;Nishtala et al 2016), questionnaires (Thorne et al, 2014;Hu et al, 2015), and a reporting system (Andreica and Grissinger, 2015). The settings of these studies were in hospitals, primary care centres, or both.…”

Section: Resultsmentioning

confidence: 99%

“…The findings of this review suggest that no studies defined MRPs involving DOACs, and ADRs and ADEs were used interchangeably. Four of the retrospective studies investigated ADRs (Larsen et al, 2013;Graham et al, 2014;Chang et al, 2015;Nishtala et al, 2016], one investigate medication errors (Andreica and Grissinger, 2015), one investigated persistence (Forslund et al, 2016), and two investigated adherence (Lee et al, 2013;Cutler et al, 2014). Furthermore, six prospective studies investigate ADRs (Donaldson and Norbeck, 2013;Ho et al, 2014;Thorne et al, 2014;Beyer-Westendorf et al, 2015;Monteagudo et al, 2015;Chan et al, 2016), one study investigate persistence (Martinez et al, 2016), and two investigate adherence (Gorst-Rasmussen et al, 2015;Hu et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…One study (Graham et al, 2014) examined ADR bleeding-related events associated with dabigatran and found a 2.2% risk of bleeding. The persistence of DOAC therapy decreased from 88.2% in year 1 to 82.9% in year two of dabigatran use (Forslund et al, 2016), and adherence was slightly different between pharmacy-managed anticoagulant care (93.1%) and non-pharmacy care (88.3%) (Lee et al, 2013). Medication errors associated with the oral anticoagulants including warfarin and DOACs were 831 incidents reported in 2014 by the Pennsylvania Patient Safety Advisory.…”

Section: Types and Causes Of Medicine-related Problems Identified Acrmentioning

confidence: 99%

See 2 more Smart Citations

Systematic Review of Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants

2017

British Journal of Pharmacy

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New oral anticoagulant agents continue to emerge on the market and their safety requires assessment to provide evidence of their suitability for clinical use. Therefore, we searched standard databases to summarize the English language literature on medicine-related problems (MRPs) of direct oral anticoagulants DOACs (dabigtran, rivaroxban, apixban, and edoxban) in the treatment of adults with atrial fibrillation. Electronic databases including Medline, Embase, International Pharmaceutical Abstract (IPA), Scopus, CINAHL, the Web of Science and Cochrane were searched from 2008 through 2016 for original articles. Studies published in English reporting MRPs of DOACs in adult patients with AF were included. Seventeen studies were identified using standardized protocols, and two reviewers serially abstracted data from each article. Most articles were inconclusive on major safety end points including major bleeding. Data on major safety end points were combined with efficacy. Most studies inconsistently reported adverse drug reactions and not adverse events or medication error, and no definitions were consistent across studies. Some harmful drug effects were not assessed in studies and may have been overlooked. Little evidence is provided on MRPs of DOACs in patients with AF and, therefore, further studies are needed to establish the safety of DOACs in real-life clinical practice.

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Incorporating Comprehensive Management of Direct Oral Anticoagulants into Anticoagulation Clinics

2017

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Anticoagulation clinics emerged as a means to optimize warfarin effectiveness and minimize bleeding risks. Anticoagulation clinics have traditionally been warfarin-based models due to the need for frequent blood-level monitoring, drug interactions, dietary considerations, and periprocedural management with warfarin. These models have demonstrated improved anticoagulation control and reduced bleeding complications for patients taking warfarin. Direct oral anticoagulants (DOACs) emerged with the perception of improved convenience due to the lack of blood-level monitoring and lack of dietary considerations. Despite the advantages of DOAC therapy, new challenges exist with their management, warranting ongoing monitoring. Such challenges include prescribing and dosing issues, drug adherence, drug interactions, and high drug cost. Comprehensive anticoagulation centers are needed to manage and monitor all oral anticoagulants including DOACs. The objectives of this review are to describe the challenges and opportunities that exist in the management of DOACs and to describe a practice model that integrates a DOAC management service into the traditional anticoagulation clinic.

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Adherence and outcomes of patients treated with dabigatran: Pharmacist-managed anticoagulation clinic versus usual care

Cited by 22 publications

References 15 publications

The Use of Electronic Personal Health Records to Improve Medication Adherence and Patient Engagement: A Randomized Study of Non-valvular Atrial Fibrillation Patients

The Use of Electronic Personal Health Records to Improve Medication Adherence and Patient Engagement: A Randomized Study of Non-valvular Atrial Fibrillation Patients

Systematic Review of Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants

Incorporating Comprehensive Management of Direct Oral Anticoagulants into Anticoagulation Clinics

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