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Patient-level adherence and interventions in an interdisciplinary DOAC clinic
Amy Shook Talana1, Katherine Huber2, Mircea Sorin2
1University of Florida College of Pharmacy, P.O. Box 100496, Gainesville, FL 32610, United States of America.
Insights
Direct oral anticoagulants (DOACs) require strict adherence due to short half-lives. A study found most patients needed interventions, with medication timing non-adherence being the most common issue.
Area of Science:
- Pharmacology
- Internal Medicine
- Patient Adherence Research
Background:
- Direct oral anticoagulants (DOACs) are crucial for preventing thrombotic events but necessitate precise adherence due to their short half-lives.
- Existing research on DOAC adherence is largely based on global measures, lacking granular patient-level data.
- This study addresses the gap by prospectively evaluating patient-level adherence to DOAC therapy.
Discussion:
- An interdisciplinary clinical pharmacy service effectively identified and addressed medication management issues in patients prescribed DOACs.
- Non-adherence, particularly to the timing of medication administration, was the most prevalent problem encountered.
- Adherence challenges were observed in a significant proportion of patients, highlighting the need for targeted interventions.
Key Insights:
- A substantial majority of patient visits (68.1%) to an interdisciplinary DOAC clinic required intervention.
- Non-adherence to dosing timing was the most frequent issue (30 visits), followed by missed doses and incorrect administration with food.
- Patients on rivaroxaban exhibited higher rates of adherence issues (61.1%) compared to those on apixaban (33.0%) in this cohort.
Outlook:
- The findings underscore the critical role of specialized clinical services in optimizing DOAC therapy and improving patient outcomes.
- Further research should explore patient-specific factors contributing to non-adherence and develop tailored educational strategies.
- Implementing routine adherence assessments within DOAC management protocols can enhance therapeutic efficacy and patient safety.
Background:
Direct oral anticoagulants (DOACs) are high risk medications with short half-lives making adherence vitally important. Global measures for adherence have been described; however, there is a lack of patient-level data on adherence.
Methods:
This prospective, single-center study in an interdisciplinary internal medicine clinic included patients referred by their primary care physician for DOAC therapy evaluation. Patients were interviewed by a clinical pharmacist who confirmed dose and indication. Adherence was evaluated by asking how it was taken, at what time(s) of the day, and how many doses of their DOAC were missed. Labs and concomitant drugs were evaluated and patients received medication counseling. If any issues arose, the pharmacist would work together with the physician to resolve them.
Findings:
Of 116 visits from 72 patients, an intervention was needed in 79 visits (68·1%). The most common problem identified was related to adherence: non-adherence to timing of dosing (n = 30), non-adherence to frequency of dosing (n = 5), and non-adherence to administration with food when indicated (n = 11). Adherence issues were present in 11 (61·1%) visits in patients taking rivaroxaban and 31 (33·0%) visits in patients taking apixaban.
Interpretation:
An interdisciplinary DOAC service provided interventions for the majority of patients referred for DOAC therapy evaluation. The most frequent problem was non-adherence, with more than a third of patients found to be non-adherent to the timing of their medication administration.
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