Medication Adherence to Direct Oral Anticoagulants
Issue
Many patients either don’t fill their initial prescriptions (primary non-adherence) or stop taking their medications after the first fill (secondary non-adherence), which can lead to worse health outcomes and higher hospital admissions. Patient cost, medication access, and health system’s variable access to fill data for systematic identification of patients needing adherence intervention as part of routine clinical care are key barriers contributing to suboptimal adherence to direct oral anticoagulants (DOAC) for patients with non-valvular atrial fibrillation (NVAF).
Project Objective
Together with a team of national experts, AMGA and 3 health care organizations (HCOs) worked to improve DOAC adherence for patients with NVAF by (1) identifying method of systematically gathering primary and secondary adherence data, and (2) implementing targeted and systematic interventions to address adherence.
Results
Healthcare organizations reported baseline primary adherence rates (mean 78%; range 60%-87%) with all groups experiencing a ~20% drop for secondary adherence (mean 54%; range 38%-67%). Results coming soon!
Interventions
More details coming soon! Interventions involved:
- Targeted cohorts selected by HCOs for interventions varied and included cardiology patients, all primary care patients, and patients of top 12 DOAC prescribers within organization.
- Interventions varied within HCOs at DOAC initiation and included engaging pharmacists, advanced practice providers (APPs), and nurses for patient outreach, an easy button for prior authorization support, systematic payment assistance support, and patient education materials and videos.
- HCOs acted on real time fill data by utilizing developed reports and standardized smartforms for outreach, patient reminders, education, and financial support measures.