Factors related to patient adherence to the use of new oral anticoagulants

To characterize the self-reported adherence of patients with cardiovascular diseases to the use of new oral anticoagulants and to identify factors related to adherence to these drugs.

Method:

This is a descriptive, correlational, and cross-sectional study, carried out with outpatients. The collection of sociodemographic, clinical, and adherence data, through the Measurement of Adherence to Treatments, was made through telephone calls. Descriptive, correlation, and multiple linear regression analyses were used.

Results:

A total of 120 patients using new anticoagulants for 32.3 months, on average, participated in the study. More than half of the sample consisted of women, who were professionally inactive, with a mean age of 70.1 years and a mean family income of 6.7 minimum wages. The mean adherence score was 5.7, in a possible range between 1 and 6, indicating medication adherence. Inactive employment status, female sex, higher family income, and follow-up at a public outpatient clinic were related to greater adherence to these medications.

Conclusion:

The patients showed high adherence to new anticoagulants. Employment status, sex, family income, and type of outpatient follow-up were related to medication adherence, and should be considered in the design of interventions for this public.

DESCRIPTORS
Medication Adherence; Anticoagulants; Nursing

Variables	N	%	Mean (SD)	Median	Range
Age (years)			70.1 (13.8)	72.5	25–93
Sex
Female	67	55.8
Male	53	44.2
Color
White	90	75.0
Nonwhite	30	25.0
With whom the person lives
Family members	101	84.8
Alone	16	13.4
Others	02	1.80
With how many people the person lives			1.7 (1.5)	1.0	0–10
Schooling (years)			9.8 (6.5)	7.0	0–25
Illiterate	16	13.3
Some elementary school	55	45.8
Complete elementary school	05	4.1
Some high school	00	0.0
Complete high school	11	9.1
Some higher education	06	5.0
Complete higher education	27	22.5
Family income (number of minimum wages)			6.7 (4.7)	5.0	1–30
Employment status
Inactive	106	88.3
Active	14	11.6
Nonemployment status
Retired/Sick pay	91	86.6
Unemployed	14	13.3
Adverse events
No	102	85.0
Yes	18	15.0
Comorbidities
Atrial fribrillation	115	95.8
Arterial hypertension	84	70.0
Dyslipidemia	57	47.5
Diabetes mellitus	36	30.0
Follow-up location
Private outpatient clinic	72	60.0
Public outpatient clinic	48	40.0
Number of drugs in use, including NOAC*			5.3 (2.5)	5.0	1–30
*NOAC usage time (months)**			32.3 (31.2)	24	1–180
MAT
MAT total score**			5.7 (0.3)	5.7	4–6
Adherence	117	97.5
Non-adherence	03	2.5

Variables	n (%)	Mean (SD)	Median	Range	p-value^*
Sex					0.102
Male	53 (44.1%)	5.6 (0.4)	5.7	4.0–6.0
Female	67 (55.9%)	5.7 (0.3)	5.9	4.7–6.0
Employment status					0.049
Active	14 (11.7%)	5.4 (0.5)	5.7	4.0–6.0
Inactive	106 (88.3%)	5.7 (0.3)	5.7	4.5–6.0
Aid to take medication					0.139
Yes	40 (33.3%)	5.7 (0.3)	5.8	5.2–6.0
No	80 (66.7%)	5.7 (0.3)	5.7	4.0–6.0
Treatment interruption					0.837
Yes	16 (13.3%)	5.6 (0.5)	5.8	4.0–6.0
No	104 (86.7%)	5.7 (0.3)	5.7	4.6–6.0
Adverse events					0.798
Yes	18 (15.09%)	5.7 (0.3)	5.7	5.4–6.0
No	102 (85.0%)	5.7 (0.3)	5.7	4.0–6.0
NOAC in use					0.673
Dabigatran	25 (20.9%)	5.7 (0.3)	5.7	5.2–6.0
Apixaban	37 (30.8%)	5.7 (0.3)	5.7	4.5–6.0
Rivaroxabana	58 (48.3%)	5.7 (0.3)	5.7	4.0–6.0

Variables	MAT r*, (p-value†)
Variables	Age	0.16 (0.078)
Length of schooling	−0.05 (0.575)
Family income	−0.047 (0.614)
Number of medicines/day	0.15 (0.100)
NOAC usage duration	−0.25 (0.006)

Independent variables	Coefficient	CI* 95%		p-value^§
Independent variables	Coefficient	LL^†	UL^‡	p-value^§
Intercept	4.98	4.49	5.48	<0.0001
Age	0.00	0.00	0.01	0.097
Length of schooling	0.01	−0.01	0.02	0.269
Number of medicines/day	0.02	−0.01	0.04	0.219
Family income	0.02	0.01	0.03	0.019
NOAC usage duration	0.00	0.00	0.00	0.109
Sex (Female)	−0.11	−0.23	−0.01	0.048
Employment status (Active)	0.26	0.05	0.47	0.014
Aid for taking medication (Yes)	−0.02	−0.15	0.12	0.803
NOAC in use (Dabigatran and Apixaban)	0.04	−0.08	0.16	0.517
Adverse events (Yes)	−0.01	−0.17	0.14	0.879
Interruption treatment past month (Yes)	0.13	−0.04	0.29	0.126
Follow-up location (Public outpatient clinic)	−0.13	−0.25	−0.02	0.025

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Paula Rocco Gomes Lima R. Tessália Vieira de Camargo 126, Cidade Universitária 13083-887 – Campinas, SP, Brazil, paularglima@gmail.com