Adherence to Warfarin Assessed by Electronic Pill Caps, Clinician Assessment, and Patient Reports: Results from the IN-RANGE Study

详细信息    查看全文

• 作者：Catherine S. Parker MS (1)
  Zhen Chen PhD (1)
  Maureen Price RN (1)
  Robert Gross MD ; MSCE (1) (2)
  Joshua P. Metlay MD ; PhD (1) (3)
  Jason D. Christie MD ; MSCE (1)
  Colleen M. Brensinger MS (1)
  Craig W. Newcomb MAR (1)
  Frederick F. Samaha MD (4)
  Stephen E. Kimmel MD ; MSCE (1)
  
• 关键词：patient adherence ; warfarin ; medication event monitoring system
• 刊名：Journal of General Internal Medicine
• 出版年：2007
• 出版时间：September 2007
• 年：2007
• 卷：22
• 期：9
• 页码：1254-1259
• 全文大小：139KB
• 参考文献：1. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med. 1998;158:1641-. CrossRef
  2. Palareti G, Leali N, Coccheri S, et al. Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy. Lancet. 1996;348:423-. CrossRef
  3. Kutner M, Nixon G, Silverstone F. Physicians-attitudes toward oral anticoagulants and antiplatelet agents for stroke prevention in elderly patients with atrial fibrillation. Arch Intern Med. 1991;151:1950-. CrossRef
  4. Bush D, Tayback M. Anticoagulation for nonvalvular atrial fibrillation: effects of type of practice on physicians-self-reported behavior. Am J Med. 1998;104:148-1. CrossRef
  5. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-7. CrossRef
  6. Kimmel SE, Chen Z, Price M, et al. The influence of patient adherence on anticoagulation control with warfarin: results from the International Normalized Ratio Adherence and Genetics (IN-RANGE) Study. Arch Intern Med. 2007;167:229-5. CrossRef
  7. Howard AF, Frewin DB, Leonello PP, Taylor WB. Compliance with anticoagulant drug therapy: a study on patients with prosthetic heart valves. Med J Aust. 1981;2:274-.
  8. Van der Meer FJ, Briet E, Vandenbroucke JP, et al. The role of compliance as a cause of instability in oral anticoagulant therapy. Br J Haematol. 1997;98:893-00. CrossRef
  9. Laporte S, Quenet S, Buchmuller-Cordier A, et al. Compliance and stability of INR of two oral anticoagulants with different half-lives: a randomised trial. Thromb Haemost. 2003;89:458-7.
  10. Butler JA, Peveler RC, Roderick P, et al. Measuring compliance with drug regimens after renal transplantation: comparison of self-report and clinician rating with electronic monitoring. Transplantation. 2004;77:786-. CrossRef
  11. Byerly M, Fisher R, Whatley K, et al. A comparison of electronic monitoring vs. clinician rating of antipsychotic adherence in outpatients with schizophrenia. Psychiatry Res. 2005;133:129-3. CrossRef
  12. Gross R, Bilker WB, Friedman HM, Coyne JC, Strom BL. Provider inaccuracy in assessing adherence and outcomes with newly initiated antiretroviral therapy. AIDS. 2002;16(13):1835-. CrossRef
  13. Pullar T, Kumar S, Tindall H, Feely M. Time to stop counting the tablets? Clin Pharmacol Ther. 1989;46:163-. CrossRef
  14. Cramer JA, Mattson RH, Prevey ML, et al. How often is medication taken as prescribed? A novel assessment technique. JAMA. 1989;261:3273-. CrossRef
  15. Urquhart J. Role of patient compliance in clinical pharmacokinetics. A review of recent research. Clin Pharmacokinet. 1994;27:202-5.
  16. Urquhart J. The electronic medication event monitor. Lessons for pharmacotherapy. Clin Pharmacokinet. 1997;32:345-6. CrossRef
  17. Wilson SJ, Wells PS, Kovacs MJ, et al. Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: a randomized controlled trial. CMAJ. 2003;169:293-.
  18. Gallus AS. Towards the safer use of warfarin: an overview. J Qual Clin Pract. 1999;19:55-. CrossRef
  19. Ansell JE, Buttaro ML, Thomas OV, Knowlton CH. Consensus guidelines for coordinated outpatient oral anticoagulation therapy management. Anticoagulation Guidelines Task Force. Ann Pharmacother. 1997;31:604-5.
  
• 作者单位：Catherine S. Parker MS (1)
  Zhen Chen PhD (1)
  Maureen Price RN (1)
  Robert Gross MD, MSCE (1) (2)
  Joshua P. Metlay MD, PhD (1) (3)
  Jason D. Christie MD, MSCE (1)
  Colleen M. Brensinger MS (1)
  Craig W. Newcomb MAR (1)
  Frederick F. Samaha MD (4)
  Stephen E. Kimmel MD, MSCE (1)
  
  1. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 717 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
  2. Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
  3. Department of Medicine, the Veterans Affairs Medical Center, Philadelphia, PA, USA
  4. Cardiovascular Division, the Veterans Affairs Medical Center and the Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  

文摘

Background Patient adherence to warfarin may influence anticoagulation control; yet, adherence among warfarin users has not been rigorously studied. Objective Our goal was to quantify warfarin adherence over time and to compare electronic medication event monitoring systems (MEMS) cap measurements with both self-report and clinician assessment of patient adherence. Design We performed a prospective cohort study of warfarin users at 3 Pennsylvania-based anticoagulation clinics and assessed pill-taking behaviors using MEMS caps, patient reports, and clinician assessments. Results Among 145 participants, the mean percent of days of nonadherence by MEMS was 21.8% (standard deviation±21.1%). Participants were about 6 times more likely to take too few pills than to take extra pills (18.8 vs. 3.3%). Adherence changed over time, initially worsening over the first 6?months of monitoring, which was followed by improvement beyond 6?months. Although clinicians were statistically better than chance at correctly labeling a participant’s adherence (odds ratio--.05, p--.015), their estimates often did not correlate with MEMS-cap data; clinicians judged participants to be “adherent-at 82.8% of visits that were categorized as moderately nonadherent using MEMS-cap data (?0% nonadherence days). Similarly, at visits when participants were moderately nonadherent by MEMS, they self-reported perfect adherence 77.9% of the time. Conclusions These results suggest that patients may benefit from adherence counseling even when they claim to be taking their warfarin or the clinician feels they are doing so, particularly several months into their course of therapy.