Development of a Conceptual Model of Adherence to Oral Anticoagulants to Reduce Risk of Stroke in Patients with Atrial Fibrillation

Brown, T. Michelle; Siu, Kimberly; Walker, David; Pladevall-Vila, Manel; Sander, Stephen; Mordin, Margaret

doi:10.18553/jmcp.2012.18.5.351

Cited by 43 publications

(32 citation statements)

References 28 publications

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“…For instance, Brown et al’s recent model is one of the first to fully recognize some potential determinants of medication adherence behavior 37. In this conceptual model of atrial fibrillation, patients’ adherence to oral anticoagulants and components include the following: predisposing, moderating, and contextual factors; knowledge base and reinforcement; short- and long-term motivation; personalized system, habit formation, and system adaptation; and a self-efficacy loop 37. This model encompasses many factors previously considered separately in theoretical models of medication adherence and targeted individually in interventions designed to improve medication adherence.…”

Section: Cvd and Medication Adherencementioning

confidence: 99%

Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team

Goldstein¹,

Gathright²,

Garcia³

2017

PPA

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Many individuals with cardiovascular disease (CVD) experience depression that is associated with poor health outcomes, which may be because of medication nonadherence. Several factors influence medication adherence and likely influence the relationship between depression and medication adherence in CVD patients. This comprehensive study reviews the existing literature on depression and medication adherence in CVD patients, addresses the methods of and problems with measuring medication adherence, and explains why the integrated care team is uniquely situated to improve the outcomes in depressed CVD patients. This paper also explores how the team can collaboratively target depressive symptoms and medication-taking behavior in routine clinical care. Finally, it suggests the limitations to the integrated care approach, identifies targets for future research, and discusses the implications for CVD patients and their families.

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Section: Cvd and Medication Adherencementioning

confidence: 99%

Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team

Goldstein¹,

Gathright²,

Garcia³

2017

PPA

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“…In our view, the ideal adherence intervention strategy would involve several facets: continuous monitoring of adherence through a direct measure such as medication variability; identification of patients who are nonadherent using a monitoring threshold; evaluation of risk factors, addressing any identified or possible risks while trying to eliminate avoidance behaviors as those commonly interfere with treatment 70 ; and continuous monitoring and re-intervention as needed 21 . Nonadherence is best viewed as a waxing and waning chronic risk, not as a disorder that can be “cured” in a one-time effort 21 .…”

Section: Treatment Of Nonadherencementioning

confidence: 99%

Monitoring drug adherence

Lieber

Helcer

Shemesh

2015

Transplantation Reviews

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Topic Medication nonadherence is prevalent in transplant recipients and is a major reason for graft loss. The present review discusses the measurement of adherence in transplant recipients and strategies to improve adherence. Sources reviewed since adherence research is not confined to transplant recipients, our literature review included studies relevant to transplant recipients as well as adherence to medical recomemndations more generally. We reviewed manuscripts in the English language indexed in PubMed Central, as well as ancillary sources of information such as textbook chapters that are not indexed. Conclusion There is no consensus in the literature about an optimal way to monitor adherence, nor is there agreement about a preferred management strategy. Until definitive studies demonstrate the effectiveness of intervention strategies, knowledge of the monitoring as well as intervention methods that are described in this review is expected to give practitioners the initial tools to deal with nonadherence as an important aspect of patient care.

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“…45,52 Brown et al (2012) built a model to consider adherence to oral anticoagulants that summarized results from 4 patient focus groups, supported and augmented by literature review. 56 Several of the themes in the model, such as avoidance of negative health consequences or developing a routine for therapy management, would be enhanced by the newer anticoagulants as opposed to warfarin. 56 Thus, the use of newer agents, requiring less monitoring, may improve patient compliance with anticoagulant therapy.…”

Section: ■■ Discussionmentioning

confidence: 99%

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Biskupiak¹,

Ghate²,

Jiao³

et al. 2013

JMCP

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In the European Union, 4.5 million people are estimated to have AF.2 Patients with untreated AF are at a 4-to 5-fold increased risk of stroke compared with those without the disease. Vitamin K antagonists (VKAs), such as warfarin, have been successfully used for many years to provide prophylaxis against stroke in patients with AF. A large meta-analysis of randomized trials showed that adjusted-dose warfarin reduced the incidence of stroke by 64%. 4 However, in a real-world analysis of Medicare patients with AF, the reduction in stroke with warfarin was lower than in the meta-analysis, at 27%. 5While effective, VKAs are associated with a number of limitations: they have numerous drug and food interactions; their effect is influenced by genetic factors; and they have a narrow therapeutic range, requiring frequent international normalized ratio (INR) monitoring and dose adjustments.6 As a result of these factors, there is considerable variability in the amount of time patients spend within the therapeutic range (INR, 2.0-3.0), which exposes them to stroke when they are below the range and bleeding when they are above the range.New anticoagulants have been developed to reduce the risk of stroke in patients with AF. These oral agents are direct inhibitors of single coagulation factors and include dabigatran, rivaroxaban, and apixaban.7 They meet the need for predictable anticoagulation with fixed dosing, without the need for laboratory monitoring. As may be expected, these anticoagulants are more expensive per unit than warfarin.7 However, the

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Development of a Conceptual Model of Adherence to Oral Anticoagulants to Reduce Risk of Stroke in Patients with Atrial Fibrillation

Cited by 43 publications

References 28 publications

Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team

Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team

Monitoring drug adherence

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

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