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Association of conflicting information from healthcare providers and poor shared decision making with suboptimal adherence in direct oral anticoagulant treatment: A cross-sectional study in patients with atrial fibrillation |
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| Authors: | Souad Moudallel Bart JF van den Bemt Hanneke Zwikker Anne de Veer Silas Rydant Liset van Dijk Stephane Steurbaut |
| Institution: | 1. Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Centre for Pharmaceutical Research (CePhar), Brussels, Belgium;2. Department of Clinical Pharmacology and Pharmacotherapy, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium;3. Department of Rheumatology and Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands;4. Dutch Institute for Rational Use of Medicine (IVM), Utrecht, the Netherlands;5. Department of Cardiology, St-Antonius Hospital, Nieuwegein, the Netherlands;6. KAVA, Royal Pharmaceutical Society of Antwerp, Antwerp, Belgium;7. NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands;1. Derner School of Psychology, Adelphi University, Garden City, NY 11530, USA;2. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549 USA;3. Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA;1. Institute for Medical Education, University of Bern, Bern, Switzerland;2. Department of Health Professions, University of Applied Sciences, Bern, Switzerland |
| Abstract: | ObjectiveTo assess direct oral anticoagulant (DOAC) adherence and to determine possible determinants for suboptimal adherence in Dutch patients with atrial fibrillation (AF).MethodsCross-sectional study of DOAC users who completed a self-reported questionnaire. Adherence was measured with Morisky8-item Medication Adherence Scale (MMAS-8). Logistic regression analysis was conducted to investigate determinants affecting adherence.Results398 DOAC users completed the questionnaire (mean age 70.6 ± 9.2years). Approximately one in four patients had suboptimal adherence (MMAS-8 < 8). Multivariable analysis showed that patients who felt to have received conflicting information about the treatment, patients with higher educational level and patients who were not sufficiently involved in the treatment choice had a higher odds of suboptimal adherence.ConclusionDOAC adherence was suboptimal. Conflicting information received from different healthcare providers (HCPs), lack of shared decision making and the patients’ educational level were determinants negatively affecting DOAC adherence.Practice implicationsEfforts towards identifying suboptimally adherent DOAC patients are needed since they are at higher risk to develop thromboembolic events. Adherence counselling should be systematically and repeatedly encouraged and shared decision making should become more mainstream. Moreover, reinforced education of both patients and HCPs combined with interprofessional collaboration are potential solutions to prevent knowledge gaps and communication of conflicting information. |
| Keywords: | Direct Oral anticoagulant Atrial fibrillation Medication adherence Shared decision making Patient education |
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