Factors Associated with Greater Dabigatran Adherence

Appropriate patient selection and pharmacist-led monitoring were linked to greater adherence to dabigatran among patients with atrial fibrillation at Veterans Health Administration sites, according to a recent study published in JAMA.

Dabigatran is a target-specific oral anticoagulant (TSOAC) that does not require periodic laboratory testing like warfarin. Earlier research has shown that suboptimal adherence to dabigatran was associated with a higher risk of stroke and death. 

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Researchers from the VA Palo Alto Health Care System and Stanford University School of Medicine studied site-level variation in adherence to dabigatran and modifiable site-level practices that improved adherence in the Veterans Health Administration (VHA). A total of 67 sites with ≥20 patients filling dabigatran prescriptions between 2010-2012 for nonvalvular atrial fibrillation (n=4,863) were included as well as 47 pharmacist from 41 eligible sites. 

Median proportion of patients adherent to dabigatran was 74%. The team found that higher adherence was seen with appropriate patient selection and pharmacist-led monitoring (eg, determining medication administration and storage, frequency of missed doses with timely lab testing). For patients who were non-adherent, pharmacist collaboration with clinicians also increased adherence rates. 

Study findings support utilizing site-level modifiable targets to improve patient adherence to dabigatran vs. patient characteristics that usually cannot be modified, researchers conclude. 

For more information visit JAMAnetwork.com

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