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Complex antithrombotic therapy: determinants of patient preference and impact on medication adherence.

Authors :
Abraham, Neena S.
Naik, Aanand D.
Street Jr., Richard L.
Castillo, Diana L.
Deswal, Anita
Richardson, Peter A.
Hartman, Christine M.
Shelton Jr., George
Fraenkel, Liana
Source :
Patient Preference & Adherence. Nov2015, Vol. 9, p1657-1668. 12p.
Publication Year :
2015

Abstract

Purpose: For years, older patients have been prescribed multiple blood-thinning medications (complex antithrombotic therapy [CAT]) to decrease their risk of cardiovascular events. These therapies, however, increase risk of adverse bleeding events. We assessed patient-reported trade-offs between cardioprotective benefit, gastrointestinal bleeding risk, and burden of self-management using adaptive conjoint analysis (ACA). As ACA could be a clinically useful tool to obtain patient preferences and guide future patient-centered care, we examined the clinical application of ACA to obtain patient preferences and the impact of ACA on medication adherence. Patients and methods: An electronic ACA survey led 201 respondents through medication risk-benefit trade-offs, revealing patients' preferences for the CAT risk/benefit profile they valued most. The post-ACA prescription regimen was categorized as concordant or discordant with elicited preferences. Adherence was measured using VA pharmacy refill data to measure persistence of use prior to and 1 year following preference-elicitation. Additionally, we analyzed qualitative interviews of 56 respondents regarding their perception of the ACA and the preference elicitation experience. Results: Participants prioritized 5-year cardiovascular benefit over preventing adverse events. Medication side effects, medication-associated activity restrictions, and regimen complexity were less important than bleeding risk and cardioprotective benefit. One year after the ACA survey, a 15% increase in adherence was observed in patients prescribed a preference-concordant CAT strategy. An increase of only 6% was noted in patients prescribed a preference-discordant strategy. Qualitative interviews showed that the ACA exercise contributed to increase inpatient activation, patient awareness of preferences, and patient engagement with clinicians about treatment decisions. Conclusion: By working through trade-offs, patients actively clarified their preferences, learning about CAT risks, benefits, and self-management. Patients with medication regimens concordant with their preferences had increased medication adherence at 1 year compared to those with discordant medication regimens. The ACA task improved adherence through enhanced patient engagement regarding treatment preferences. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
1177889X
Volume :
9
Database :
Academic Search Index
Journal :
Patient Preference & Adherence
Publication Type :
Academic Journal
Accession number :
111401601
Full Text :
https://doi.org/10.2147/PPA.S91553