Research from Providence CORE and the Providence Heart Institute of Oregon asked AFib patients and providers about barriers to anticoagulant medication adherence. Findings point to a mix of factors, including good patient-provider relationships, good communication and a stable living environment.
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AFib is a common heart rhythm disorder and a major and growing contributor to stroke risk, accounting for up to one in five ischemic strokes in the United States.
To reduce this risk, clinicians prescribe anticoagulants. These medications help prevent blood clots and can reduce the risk of stroke among patients with AFib. However, decades of research have shown that medication adherence is a persistent challenge for many patients and among all disease types.
A study by Providence CORE and partners at the Providence Heart Institute of Oregon and Pfizer sought to better understand what drives that challenge for AFib patients.
Findings point to a mix of factors, including good clinician-patient relationships, communication, and a stable living environment.
Read highlights below or view the peer-reviewed paper in the journal Patient Preference & Adherence.
Key findings: patient-provider communication, unmet social needs, and other factors
CORE sent surveys to 2000 AFib patients with an anticoagulant prescription and 2700 Providence providers. Over 200 patients and 78 providers responded. CORE also conducted 28 follow-up interviews with patients.
According to Mary Imboden, principal research scientist with Providence St. Vincent Medical Center, “patients who felt unheard by their clinician, were not actively involved in their treatment decisions, or left visits with unanswered questions were significantly more likely to be non-adherent to their prescribed medications.”
“We also found that patients who reported one or more social needs, such as housing, transportation or help with day-to-day activities, had an increased risk of non-adherence,” she added.
“On the other hand, patients who felt respected, heard, and supported by their clinicians, and who believed their questions were fully addressed, were more likely to take their medications as prescribed,” Imboden continued.
Where patients and provider views differed
Nearly 70% of patient respondents said they took their anticoagulants as prescribed. The 32% who didn’t named their relationship with their clinician, transportation issues, and other challenges as the reasons for not taking their medications.
In contrast, most AFib providers perceived adherence as much lower. They also had different ideas about what might help.
When asked what tools would help them better assess and improve adherence, physicians focused on access to actionable information at the point of care. For example, medication costs, patients’ insurance formularies, potential interactions between anticoagulants and other prescribed medications, and information about side effects. They also emphasized the value of having patient-specific stroke risk scores readily available within the patient’s electronic health record.
“Our findings highlight why it’s so important to look at areas like medication adherence through the views and experiences of both patients and providers,” said Monique Gill, Research Scientist at CORE. “Patients focused on communication and everyday challenges like transportation that can make it difficult to stay up on their medications; clinicians emphasized access to information and clinical resources. Recognizing and addressing both perspectives is essential.”
Portions of this story were re-blogged from AFib patients more likely to stay on medications when they have a good clinician relationship, Providence study finds
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