Evaluation of a pharmacist-led intervention to improve medication adherence in patients initiating dabigatran treatment: a comparison with standard pharmacy practice in Poland

Abstract

Backround Dabigatran is a direct thrombin inhibitor used to treat cardiac arrhythmias, and rates of non-adherence to dabigatran in Polish populations are high. The current study examined how a pharmacist-led intervention of counselling with pictogram-enhanced medication instructions, and smartphone medication reminders, can improve adherence to dabigatran. Methods A 3-month pharmacist-led intervention was conducted in community pharmacies in Poland on 325 men and women filling a dabigatran prescription for the first time. Participating pharmacies were assigned into the Control Group (n = 172 patients) or the Intervention Group (n = 153 patients). The primary outcome of this prospective study was self-reported medication adherence assessed at 3 time points (day 7, day 21, and day 90) after initiation of dabigatran. Results Patients in the Intervention Group were significantly more adherent (mean days on Dabigatan/week) than the Control Group at 7 days (6.0 ± 0.9 vs 5.4 ± 1.1, p < 0.0001), 21 days (5.6 ± 1.0 vs 4.9 ± 1.3, p < 0.0001), and 90 days (5.5 ± 1.3 vs 4.4 ± 2.0, p < 0.0001), respectively. The percentage of patients in the Intervention Group who reported taking dabigatran twice/day as prescribed was significantly higher than the Control Group at 7 days (82.7% vs 71.4%, p = 0.0311), at 21 days (84.4% vs 58%, p < 0.0001), and at 90 days (78.4% vs 39.7%, p < 0.0001), respectively. The proportion of patients fully adherent (every day, twice/day) at 90 days was significantly higher in the Intervention Group than in the Control Group (26.1% vs 13.2%, p = 0.0145). Conclusions Our findings support the role for interventions in community pharmacies in Poland to improve medication adherence, thus providing evidence for the efficacy of a pharmacist-led pictogram and smartphone-based program to support optimal dabigatran treatment.

COVID-19 Patients’ Medication Management during Transition of Care from Hospital to Virtual Care: A Cross-Sectional Survey and Audit

“…A study conducted in the Netherlands showed that both patients and healthcare professionals preferred face-toface consultations over telemedicine for new patients, e.g., hospital discharge patients [60]. Future transfer to virtual care models should explore various telehealth models, e.g., video counselling, which could incorporate the use of tools such as pictograms and smartphone programs, as these have been proven effective in supporting patients' understanding and subsequent medication adherence [61]. The lack of pharmacist face-to-face contact with patients may also have negatively impacted on the prioritisation of patients for medication management services.…”

Pharmacy-Led Management of Atrial Fibrillation: Improving Treatment Adherence and Patient Outcomes

“…Similarly, a community pharmacist-led intervention using the UK New Medicines Service (NMS) framework was piloted in Poland to see if adherence to dabigatran, previously reported as being suboptimal in 50% of AF patients 133 was improved. 134 The study demonstrated that using a combination of in-person, involving face-to-face (medication reconciliation, patient education, side-effect management); telephone calls (motivational interviewing around adherence challenges and barriers to adherence) and indirect involving pictogram-enhanced information leaflet and medication labels, smartphone daily medication reminders, correlated with better adherence to dabigatran than a control group receiving regular dispensing care. Over 3 months, the study found that patients receiving the intervention were significantly more adherent to their prescribed dose (twice/day) at each time point, than the control group receiving standard care (82.7% vs 71.4% - day 7; 84.4% vs 58% - day 21; 78.4% vs 39.7% - day 90).…”

Enhancing Patient Adherence to Newly-Prescribed Medicine for Chronic Diseases: A Comprehensive Review and Cost-Effective Approach to Implementing the New Medicine Service in Community Pharmacies in Poland

“…Numerous studies have shown that pharmacists are willing to extend their services to play a greater role in public health. The NMS has been also implemented in Poland [ 33 , 34 ], where this service was a part of the project “Closer to the Patient”. The findings demonstrated that the use of pharmaceutical intervention in the study group translated into improved adherence to medical instructions regarding correct pharmacotherapy [ 35 ]…”