There is variability in patient medication adherence across Veterans Health Administration (VHA) sites for patients with nonvalvular atrial fibrillation (AFib) treated with dabigatran, and pharmacist-based activities may be associated with greater medication adherence, according to a study published April 14 in the Journal of the American Medical Association.

The study was led by Mintu P. Turakhia, MD, MAS, FACC, of the VA Palo Alto Health Care System and Stanford University School of Medicine, and looked at 67 VHA sites with 20 or more patients filling dabigatran prescriptions between 2010 and 2012 for nonvalvular AFib (4,863 total patients; median, 51 patients per site), and also included 47 pharmacists from 41 eligible sites.

Results showed that the median proportion of patients who were adherent to dabigatran was 74 percent, with variation in patient adherence across VHA sites. The proportion of adherent patients was higher at sites performing appropriate selections (75 percent vs. 69 percent), patient education (76 percent vs. 66 percent), and maintained monitoring (77 percent vs. 65 percent).

“Our results highlight the importance of selecting patients and monitoring strategies to translate the efficacy of target-specific oral anticoagulants in randomized trials to clinical practice,” the researchers conclude. “Prior studies have described variation in patient performance on warfarin across sites further highlighting the importance of management strategies in improving patient performance to anticoagulants.” They add that the higher adherence rates associated with provision of dedicated monitoring even for a short time is potentially due to consistent contact made with patients.

Keywords: Anticoagulants, Atrial Fibrillation, Benzimidazoles, Medication Adherence, Patient Compliance, Pharmacists, United States Department of Veterans Affairs, Universities, Veterans Health, Warfarin, beta-Alanine

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