A QUALITATIVE EXPLORATION OF REASONS FOR (NON-) ADHERENCE TO ORAL ANTICOAGULANT THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION.
Author(s)
Vaanholt MC1, Weernink MG1, IJzerman MJ1, von Birgelen C2, van Til JA1
1MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands, 2Medisch Spectrum Twente, Enschede, The Netherlands
OBJECTIVES: In chronic conditions like atrial fibrillation (AF) up to half of the patients do not take their drugs as prescribed. The aim of this study was to examine patients’ reasons for (non-) adherence to oral anticoagulant therapy (OAT). METHODS: Factors impacting OAT adherence were first examined through literature review. The results were validated in an expert-panel consisting of eight key informants with expertise in the field of OAT. This was followed by five focus groups with patients with AF from the United Kingdom, Germany, France, Italy and Spain (n=48). A trained moderator led each 60-minute audio-recorded group using a structured interview guide discussing factors that might impact OAT adherence: socio-economic factors, health system-related factors, therapy-related factors, patient-related factors and condition-related factors. RESULTS: Initially, all patients reported to take their medication as prescribed, mentioning fear for AF-related stroke as their greatest motivator. When prompted by specific questions, patients admitted they occasionally skip or miss a dose. A total of 178 positive and 185 negative statements with regard to factors impacting OAT were made. Lack of knowledge (n=11); poor patient-doctor relationship (n=14), distraction due to employment or social environment (n=12), prior bleeding event(s) or the fear of bleeding (n=11); and changes in routine (n=16) were most often named as barriers to adherence, while patient-related factors such as medication-taking habits and routines (n=30); patients’ personality, motivation and attitudes (n=40) and good quality services (n=37) promote adherence. CONCLUSIONS: Modifiable factors that could impact OAT adherence include patient knowledge; satisfaction with quality of care; and patient-related factors like attitude and habit/skills. Physicians should take more time to listen to patients, explain the treatment rationale and educate them on risk and benefits of OAT. Furthermore, it is important to convince patients of the importance to evolve habits and routines in taking their oral anticoagulation drugs
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PCV110
Topic
Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
Cardiovascular Disorders