Amy Shook Talana1, Katherine Huber2, Mircea Sorin2, Carolyn Stalvey2, Kyle Davis3, Eric Dietrich4. 1. University of Florida College of Pharmacy, P.O. Box 100496, Gainesville, FL 32610, United States of America. Electronic address: amyshook@ufl.edu. 2. University of Florida College of Medicine, P.O. Box 100496, Gainesville, FL 32610, United States of America. 3. Wake Forest Baptist Medical Center, P.O. Box 100496, Gainesville, FL 32610, United States of America. 4. University of Florida College of Pharmacy, P.O. Box 100496, Gainesville, FL 32610, United States of America.
Abstract
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.
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.