Pharmacists Are Best Bet for Blood Thinner Adherence

Pharmacist-driven drug management programs best ensure atrial fibrillation patients adhere to the warfarin alternative, dabigatran (Pradaxa).

Pointing to previous studies suggesting nonvalvular atrial fibrillation (NVAF) patients are not adhering to treatment as well with the new blood thinner, researchers examined 67 Veterans Health Administration (VA) pharmacy sites with 20 or more patients filling dabigatran prescriptions between 2012 and 2012 for NVAF. They also conducted in-depth phone interviews with 47 pharmacists from 41 of those sites.

Their analysis showed pharmacist-led education about the drug was provided at 30 sites and pharmacist-led patient monitoring was performed at 28 sites. NVAF patients were 80% more likely to adhere to dabigatran when pharmacists monitored them on a regular basis, compared with those who did not receive such support.

Longer monitoring duration and more intensive care for nonadherent patients in collaboration with the clinician also improved dabigatran adherence, the researchers found.

The strong adherence rates seen in the program were attributed to pharmacists’ abilities to educate patients about medication adherence, review any possible drug interactions, follow-up to ensure patients are actually following their treatment regimens, and verifying prescriptions are refilled on time.

“Although pharmacist-led management of these new drugs is uncommon in the US, the findings make the case that it is still important and can ultimately impact clinical outcomes,” senior study author Mintu Turakhia, MD, said in a press release. “…We’re suggesting that greater structured management of these patients, beyond the doctor just prescribing medications for them, is a good idea. Extra support, like that provided in the VA anticoagulation clinics with supportive pharmacist care, greatly improves medication adherence.”