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Adherence to Antithrombotic Therapy for Patients Attending a Multidisciplinary Thrombosis Service in Canada - A
Kwadwo Osei Bonsu1, Stephanie Young1,2, Tiffany Lee1,2
1School of Pharmacy, Memorial University of Newfoundland and Labrador, St John's, NL, A1B 3V6, Canada.
Insights
Medication adherence for antithrombotic therapy is high (88%) in a multidisciplinary thrombosis service. However, prolonged treatment duration and higher education levels were associated with decreased adherence.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Poor medication adherence increases complication risks for patients on antithrombotic therapy.
- A multidisciplinary Adult Outpatient Thrombosis Service was established in 2017.
- Assessing medication adherence in this patient population was a key interest.
Purpose of the Study:
- To evaluate adherence to antithrombotic medications among patients attending a specialized multidisciplinary Thrombosis Service.
- To identify factors influencing adherence to anticoagulant and antiplatelet therapies.
Main Methods:
- A cross-sectional survey was conducted with outpatients from 2017-2019.
- The 12-item Adherence to Refills and Medications Scale (ARMS) was used to assess adherence.
- Linear regression analysis identified factors associated with adherence.
Main Results:
- 88% of participants demonstrated adherence to antithrombotic treatment (ARMS score 12-16).
- Patients with post-graduate education showed 0.4% lower adherence compared to those with elementary education (p=0.048).
- Longer antithrombotic therapy duration (>5 years) correlated with 0.5% lower adherence versus <1 year (p=0.0244).
Conclusions:
- High self-reported adherence (88%) was observed in patients within the multidisciplinary Thrombosis Service.
- Factors such as advanced education and extended duration of antithrombotic therapy are linked to reduced adherence.
- These findings highlight potential areas for targeted interventions to improve long-term medication adherence.
Background:
Poor medication adherence puts patients who require antithrombotic therapy at greater risk of complications. We started a multidisciplinary Adult Outpatient Thrombosis Service in 2017 in a Canadian health authority and were interested in the level of medication adherence in the population attending.
Aims:
The aim of this study is to assess adherence to antithrombotic medications for patients attending a multidisciplinary Thrombosis Service.
Methods:
We conducted a cross-sectional survey of outpatients seen at the Thrombosis Service between 2017 and 2019 using the 12-item validated Adherence to Refills and Medications Scale (ARMS) to assess adherence to antithrombotic (anticoagulants and antiplatelet) therapy. Linear regression analysis examined the factors associated with adherence to antithrombotic therapy.
Results:
Of 1058 eligible patients, 53.2% responded to the survey. Seventeen were excluded from the analysis for missing more than 6 responses to the 12 items on the ARMS. About 55% (n = 297) were on direct oral anticoagulants (DOACs), 19% (n = 102) on warfarin, 5.0% (n = 27) on low molecular weight heparin, 3.3% (n = 18) on antiplatelet therapy and 18% (n = 96) were no longer on antithrombotic therapy. Nearly half (47%, n = 253) had taken antithrombotic therapy for 1-5 years while 28% (n = 150) and 25% (n = 137) had taken antithrombotic treatments for <1 and >5 years, respectively. Most patients (87%, n = 475) were ≥50 years and half (51%, n = 277) were male. The mean adherence score was 13.9 (SD±2.2) and 88% (n = 481) of participants were adherent to antithrombotic treatment (ARMS = 12-16). Multivariable linear regression showed that patients with post-graduate education had 0.4% lower adherence to antithrombotic therapy as compared with elementary education (β = 0.0039, p = 0.048). Patients with prior antithrombotic agent use >5 years had 0.5% lower adherence to antithrombotic treatment compared to patients with <1 year (β = 0.0047, p = 0.0244).
Conclusion:
Self-reported adherence to antithrombotic therapy was high (88%) within a multidisciplinary Thrombosis Service. Patients with advanced education and prolong duration of antithrombotic therapy were more likely to have lower self-reported adherence to antithrombotic treatment.
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