Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants

Andreas Capiau; Els Mehuys; Inge Van Tongelen; Thierry Christiaens; An De Sutter; Stephane Steurbaut; Souad Moudallel; Silas Rydant; Bernard Vrijens; Tine L M de Backer; Koen Boussery

doi:10.1136/heartjnl-2020-316781

Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants

Andreas Capiau, Els Mehuys, Inge Van Tongelen, Thierry Christiaens, An De Sutter, Stephane Steurbaut, Souad Moudallel, Silas Rydant, Bernard Vrijens, Tine L M de Backer, Koen Boussery

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Abstract

OBJECTIVE: This study aimed to assess implementation adherence (how well the patient's actual intake matches the prescribed dosing regimen) to non-vitamin K antagonist oral anticoagulants (NOACs) and to explore experiences with and beliefs about NOACs in a real-world sample of long-term NOAC users.

METHODS: A cross-sectional observational study was conducted in home-dwelling adults who started taking a NOAC at least 1 year prior to inclusion. Pharmacy dispensing data were used to calculate the Medication Possession Ratio (MPR). Patients were recruited in 158 community pharmacies in Flanders, Belgium. They completed a questionnaire collecting basic characteristics and exploring self-reported adherence to NOACs (using the Medication Adherence Report Scale, MARS) and experiences with and beliefs about NOACs (using the Beliefs about Medicines Questionnaire, BMQ).

RESULTS: A total of 766 patients (mean age 76.2±8.8 years, median CHA2DS2-VASc score 4 (IQR=3-4)) were included. The majority (93.5%) used NOAC for stroke prevention in atrial fibrillation. The median MPR was 95.2% (IQR=87.8-99.7) which corresponds with half of the study population not taking their NOAC on at least 17 cumulative days per year. Almost 21% of participants reported non-adherence on the MARS (score <25), with unintentional non-adherence (forgetfulness) most frequently reported (15.4%). Although two-thirds of NOAC users indicated to experience adverse drug reactions, the BMQ demonstrated a positive attitude towards NOAC therapy, where necessity beliefs outweigh the concerns.

CONCLUSIONS: Our data indicate that long-term NOAC users have high implementation adherence and a positive attitude towards NOAC therapy. However, taking into account patients' thromboembolic risk and NOACs' short half-lives, further optimisation of NOAC use seems warranted in this population.

Original language	English
Article number	heartjnl-2020-316781
Pages (from-to)	1740-1746
Number of pages	7
Journal	Heart (British Cardiac Society)
Volume	106
Issue number	22
Early online date	23 Jun 2020
DOIs	https://doi.org/10.1136/heartjnl-2020-316781
Publication status	Published - Nov 2020

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Capiau, A., Mehuys, E., Van Tongelen, I., Christiaens, T., De Sutter, A., Steurbaut, S., Moudallel, S., Rydant, S., Vrijens, B., de Backer, T. L. M., & Boussery, K. (2020). Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants. Heart (British Cardiac Society) , 106(22), 1740-1746. Article heartjnl-2020-316781. https://doi.org/10.1136/heartjnl-2020-316781

@article{9aeba79544fd475cb686d62f5ba98e27,

title = "Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants",

abstract = "OBJECTIVE: This study aimed to assess implementation adherence (how well the patient's actual intake matches the prescribed dosing regimen) to non-vitamin K antagonist oral anticoagulants (NOACs) and to explore experiences with and beliefs about NOACs in a real-world sample of long-term NOAC users.METHODS: A cross-sectional observational study was conducted in home-dwelling adults who started taking a NOAC at least 1 year prior to inclusion. Pharmacy dispensing data were used to calculate the Medication Possession Ratio (MPR). Patients were recruited in 158 community pharmacies in Flanders, Belgium. They completed a questionnaire collecting basic characteristics and exploring self-reported adherence to NOACs (using the Medication Adherence Report Scale, MARS) and experiences with and beliefs about NOACs (using the Beliefs about Medicines Questionnaire, BMQ).RESULTS: A total of 766 patients (mean age 76.2±8.8 years, median CHA2DS2-VASc score 4 (IQR=3-4)) were included. The majority (93.5%) used NOAC for stroke prevention in atrial fibrillation. The median MPR was 95.2% (IQR=87.8-99.7) which corresponds with half of the study population not taking their NOAC on at least 17 cumulative days per year. Almost 21% of participants reported non-adherence on the MARS (score <25), with unintentional non-adherence (forgetfulness) most frequently reported (15.4%). Although two-thirds of NOAC users indicated to experience adverse drug reactions, the BMQ demonstrated a positive attitude towards NOAC therapy, where necessity beliefs outweigh the concerns.CONCLUSIONS: Our data indicate that long-term NOAC users have high implementation adherence and a positive attitude towards NOAC therapy. However, taking into account patients' thromboembolic risk and NOACs' short half-lives, further optimisation of NOAC use seems warranted in this population.",

author = "Andreas Capiau and Els Mehuys and {Van Tongelen}, Inge and Thierry Christiaens and {De Sutter}, An and Stephane Steurbaut and Souad Moudallel and Silas Rydant and Bernard Vrijens and {de Backer}, {Tine L M} and Koen Boussery",

note = "{\textcopyright} Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2020",

month = nov,

doi = "10.1136/heartjnl-2020-316781",

language = "English",

volume = "106",

pages = "1740--1746",

journal = "Heart (British Cardiac Society) ",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

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Capiau, A, Mehuys, E, Van Tongelen, I, Christiaens, T, De Sutter, A, Steurbaut, S, Moudallel, S, Rydant, S, Vrijens, B, de Backer, TLM & Boussery, K 2020, 'Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants', Heart (British Cardiac Society) , vol. 106, no. 22, heartjnl-2020-316781, pp. 1740-1746. https://doi.org/10.1136/heartjnl-2020-316781

TY - JOUR

T1 - Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants

AU - Capiau, Andreas

AU - Mehuys, Els

AU - Van Tongelen, Inge

AU - Christiaens, Thierry

AU - De Sutter, An

AU - Steurbaut, Stephane

AU - Moudallel, Souad

AU - Rydant, Silas

AU - Vrijens, Bernard

AU - de Backer, Tine L M

AU - Boussery, Koen

PY - 2020/11

Y1 - 2020/11

N2 - OBJECTIVE: This study aimed to assess implementation adherence (how well the patient's actual intake matches the prescribed dosing regimen) to non-vitamin K antagonist oral anticoagulants (NOACs) and to explore experiences with and beliefs about NOACs in a real-world sample of long-term NOAC users.METHODS: A cross-sectional observational study was conducted in home-dwelling adults who started taking a NOAC at least 1 year prior to inclusion. Pharmacy dispensing data were used to calculate the Medication Possession Ratio (MPR). Patients were recruited in 158 community pharmacies in Flanders, Belgium. They completed a questionnaire collecting basic characteristics and exploring self-reported adherence to NOACs (using the Medication Adherence Report Scale, MARS) and experiences with and beliefs about NOACs (using the Beliefs about Medicines Questionnaire, BMQ).RESULTS: A total of 766 patients (mean age 76.2±8.8 years, median CHA2DS2-VASc score 4 (IQR=3-4)) were included. The majority (93.5%) used NOAC for stroke prevention in atrial fibrillation. The median MPR was 95.2% (IQR=87.8-99.7) which corresponds with half of the study population not taking their NOAC on at least 17 cumulative days per year. Almost 21% of participants reported non-adherence on the MARS (score <25), with unintentional non-adherence (forgetfulness) most frequently reported (15.4%). Although two-thirds of NOAC users indicated to experience adverse drug reactions, the BMQ demonstrated a positive attitude towards NOAC therapy, where necessity beliefs outweigh the concerns.CONCLUSIONS: Our data indicate that long-term NOAC users have high implementation adherence and a positive attitude towards NOAC therapy. However, taking into account patients' thromboembolic risk and NOACs' short half-lives, further optimisation of NOAC use seems warranted in this population.

AB - OBJECTIVE: This study aimed to assess implementation adherence (how well the patient's actual intake matches the prescribed dosing regimen) to non-vitamin K antagonist oral anticoagulants (NOACs) and to explore experiences with and beliefs about NOACs in a real-world sample of long-term NOAC users.METHODS: A cross-sectional observational study was conducted in home-dwelling adults who started taking a NOAC at least 1 year prior to inclusion. Pharmacy dispensing data were used to calculate the Medication Possession Ratio (MPR). Patients were recruited in 158 community pharmacies in Flanders, Belgium. They completed a questionnaire collecting basic characteristics and exploring self-reported adherence to NOACs (using the Medication Adherence Report Scale, MARS) and experiences with and beliefs about NOACs (using the Beliefs about Medicines Questionnaire, BMQ).RESULTS: A total of 766 patients (mean age 76.2±8.8 years, median CHA2DS2-VASc score 4 (IQR=3-4)) were included. The majority (93.5%) used NOAC for stroke prevention in atrial fibrillation. The median MPR was 95.2% (IQR=87.8-99.7) which corresponds with half of the study population not taking their NOAC on at least 17 cumulative days per year. Almost 21% of participants reported non-adherence on the MARS (score <25), with unintentional non-adherence (forgetfulness) most frequently reported (15.4%). Although two-thirds of NOAC users indicated to experience adverse drug reactions, the BMQ demonstrated a positive attitude towards NOAC therapy, where necessity beliefs outweigh the concerns.CONCLUSIONS: Our data indicate that long-term NOAC users have high implementation adherence and a positive attitude towards NOAC therapy. However, taking into account patients' thromboembolic risk and NOACs' short half-lives, further optimisation of NOAC use seems warranted in this population.

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U2 - 10.1136/heartjnl-2020-316781

DO - 10.1136/heartjnl-2020-316781

M3 - Article

C2 - 32576607

SN - 1355-6037

VL - 106

SP - 1740

EP - 1746

JO - Heart (British Cardiac Society)

JF - Heart (British Cardiac Society)

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M1 - heartjnl-2020-316781

ER -

Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants

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