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A little help from pharmacists helps a-fib patients adhere to prescriptions

TurakhiaIt's not always easy to take drugs as prescribed — life often gets in the way of taking a pill at the same time each day. And it's relatively easy to ignore the tiny printing on a medication container, to rationalize why that doesn't apply to you, or how a few exceptions certainly wouldn't hurt.

Except sometimes precise prescription adherence is important. And that's the case for a new class of blood thinners such as dabigatran that are used to treat atrial fibrillation.

With these twice-daily oral drugs, "even missing a few doses can lead to acute events such as stroke," said Mintu Turakhia, MD. Along with other researchers, Turakhia was puzzled when he learned that patients weren't adhering very well to these drugs. It seemed surprising because the drugs didn't require frequent blood tests like warfarin, the traditional blood thinner used to treat atrial fibrillation.

Digging into the data, Turakhia and his team found that adherence varied by treatment site, not by individual patient. How odd, they thought. To figure out what was going on, "we rolled up our sleeves and looked at what each site was doing," Turakhia said.

My colleague explained the result of the researchers' work, which appears today in the Journal of the American Medical Association, in a release:

At the sites with the highest patient adherence, there was usually a pharmacist actively educating patients on medication adherence, reviewing any possible drug interactions, and following up to make sure patients were taking the medication when they were supposed to and that prescriptions were being refilled on time...

"We're suggesting that greater structured management of these patients, beyond the doctor just prescribing medications for them, is a good idea," Turakhia said. "Extra support, like that provided in the VA anticoagulation clinics with supportive pharmacist care, greatly improves medication adherence."

Previously: One label fits all? A universal schedule for prescription drugs, Raising awareness about the importance of taking medications properly and Study highlights increased risk of death among patients with atrial fibrillation who take digoxin
Photo of Turakhia by Norbert von der Groeben

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