Patient-level adherence and interventions in an interdisciplinary DOAC clinic

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.