Site-level variation in and practices associated with dabigatran adherence.

摘要: Importance Unlike warfarin, which requires routine laboratory testing and dose adjustment, target-specific oral anticoagulants like dabigatran do not. However, optimal follow-up infrastructure modifiable site-level factors associated with improved adherence to are unknown. Objectives To assess variation in identify practices higher adherence. Design, Setting, Participants Mixed-methods study involving retrospective quantitative cross-sectional qualitative data. A total of 67 Veterans Health Administration sites 20 or more patients filling prescriptions between 2010 2012 for nonvalvular atrial fibrillation were sampled (4863 patients; median, 51 per site). Forty-seven pharmacists from 41 eligible participated the inquiry. Exposure Site-level identified included appropriate patient selection, pharmacist-driven education, pharmacist-led adverse event monitoring. Main Outcomes Measures Dabigatran (intensity drug use during therapy) defined by proportion days covered (ratio supplied prescription duration) 80% more. Results The median adherent was 74% (interquartile range [IQR], 66%-80%). After multivariable across varied a odds ratio 1.57. Review participating showed that selection performed at 31 sites, education provided 30 monitoring 28 sites. performing (75% vs 69%), (76% 66%), (77% 65%). Following association not statistically significant (relative risk [RR], 0.94; 95% CI, 0.83-1.06). Appropriate (RR, 1.14; 1.05-1.25), provision 1.25; 1.11–1.41) better Additionally, longer duration providing intensive care nonadherent collaboration clinician Conclusions Relevance Among treated dabigatran, there variability medication Specific pharmacist-based activities greater dabigatran.