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Association Between Patient-Reported Medication Adherence and Anticoagulation Control.

Jonathan Sevilla-Cazes1, Brian S Finkleman2, Jinbo Chen3

  • 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

The American Journal of Medicine
|April 30, 2017
PubMed
Summary

Predicting medication adherence for preventing thromboembolism is difficult. Real-time self-reported adherence, using a visual analogue scale (VAS) and 7-day recall, correlates with anticoagulation control, improving patient management.

Keywords:
AnticoagulationMedication adherenceSelf-reportVisual analogue scaleWarfarin

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Area of Science:

  • Pharmacology and Therapeutics
  • Clinical Medicine
  • Patient Adherence Research

Background:

  • Thromboembolism event prevention is hindered by poor medication adherence.
  • Current clinical prediction of future adherence is suboptimal.
  • Real-time adherence measures are needed to improve anticoagulation control.

Purpose of the Study:

  • To examine the correlation between two measures of real-time, self-reported adherence and anticoagulation control.
  • To assess the utility of visual analogue scale (VAS) and 7-day recall for adherence monitoring.
  • To identify predictors of suboptimal anticoagulation control in warfarin therapy.

Main Methods:

  • Recruited patients initiating warfarin therapy in urban anticoagulation clinics.
  • Collected real-time adherence data using VAS and 7-day recall at study visits.
  • Measured anticoagulation control via between-visit percent time in international normalized ratio range (BVTR).
  • Employed generalized estimating equations to analyze the longitudinal association between adherence and BVTR.

Main Results:

  • Poorer anticoagulation control (BVTR < median) was associated with VAS adherence ≤80% (OR 1.89, P=.02).
  • Self-reported changes in adherence since the last visit also predicted poorer anticoagulation control (OR 1.55, P=.001).
  • These adherence measures provide valuable insights into anticoagulation management.

Conclusions:

  • Self-reported VAS adherence and changes in adherence are independently associated with BVTR.
  • Incorporating real-time adherence data can enhance clinical insights into patient medication management.
  • This study highlights the importance of real-time adherence monitoring for optimizing anticoagulation therapy.