Site-level variation in and practices associated with dabigatran adherence.

Area of Science:

• Pharmacology
• Health Services Research
• Internal Medicine

Background:

• Target-specific oral anticoagulants (TSOACs) like dabigatran offer advantages over warfarin by not requiring routine laboratory monitoring.
• However, understanding optimal follow-up strategies and site-level factors influencing dabigatran adherence remains crucial.

Purpose of the Study:

• To evaluate variations in dabigatran adherence across different healthcare sites.
• To identify specific site-level practices that correlate with improved dabigatran adherence.

Main Methods:

• A mixed-methods approach combining retrospective quantitative data (67 Veterans Health Administration sites, 4863 patients) and qualitative data from 47 pharmacists.
• Adherence was defined as a proportion of days covered (PDC) of 80% or more.

Main Results:

• Median patient adherence to dabigatran was 74%, with significant site-level variation (median odds ratio of 1.57).
• Appropriate patient selection and pharmacist-led monitoring were associated with higher adherence rates (RR, 1.14 and 1.25, respectively).
• Pharmacist-led education did not show a statistically significant association with adherence.

Conclusions:

• Significant variability exists in dabigatran adherence among nonvalvular atrial fibrillation patients across healthcare sites.
• Implementing specific pharmacist-driven activities, particularly patient selection and ongoing monitoring, can enhance medication adherence.