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Journal of the American Medical Association

Clinical Articles, News & Views

Pharmacist monitoring improves adherence to NOACs

Adherence to dabigatran treatment varies between Veterans Health Administration sites, among nonvalvular atrial fibrillation patients treated with dabigatran, according to a study published recently in the Journal of the American Medical Association.1

A total of 67 Veterans Health Administration sites with 20 or more patients filling dabigatran prescriptions between 2010 and 2012 for nonvalvular atrial fibrillation were sampled (4,863 total patients; median, 51 patients per site). 47 pharmacists from 41 eligible sites participated in the qualitative inquiry. Dabigatran adherence was defined by proportion of days covered (ratio of days supplied by prescription to follow-up duration) of 80% or more.

The median proportion of patients adherent to dabigatran was 74% (interquartile range [IQR], 66%-80%). After multivariable adjustment, dabigatran adherence across sites varied by a median odds ratio of 1.57. Review of practices across participating sites showed that appropriate patient selection was performed at 31 sites, pharmacist-led education was provided at 30 sites, and pharmacist-led monitoring at 28 sites.

The proportion of adherent patients was higher at sites performing appropriate selection (75% vs 69%), education (76% vs 66%), and monitoring (77% vs 65%). Following multivariable adjustment, association between pharmacist-led education and dabigatran adherence was not statistically significant. Appropriate patient selection, and provision of pharmacist-led monitoring, were associated with better patient adherence. Additionally, longer duration of monitoring and providing more intensive care to non-adherent patients in collaboration with the clinician improved adherence.


1. Shore S, Ho PM, Lambert-Kerzner A, et al. Site-level variation in and practices associated with dabigatran adherence. J Am Med Assoc 2015;313:1443–50.

Published on: June 26, 2015

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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