The 19 item Compliance-Questionnaire-Rheumatology (CQR)1 is an open access questionnaire that was developed by Rheumatologists in the Netherlands, to predict the potential for non-adherence specifically in Rheumatology patients. It was validated against gold standard compliance measures. The questionnaire item bank was developed from the literature, home interviews and focus groups. Responses are provided on a 4-point Likert scale delineated by strength of agreement (don't agree at all, don't agree, agree, agree very much).
Objectives
To quantify the proportion of respondents that would fall into each adherence risk category when administered on a large scale and to assess the potential for further validation of the questionnaire.
Methods
Patients self-reporting a diagnosis of rheumatoid arthritis (RA) and residing in the United States completed a self-administered, internet-based questionnaire in Fall 2011, which included the CQR. CQR data were analysed using an automated analytical tool provided by the developers. Based on the validation paper, individual raw CQR questions are weighted to produce adjusted total summary scores for each patient, which can then be compared to validated cutoff values for specified levels of desired compliance ranging from 50-95%, to establish whether the patient is or is not likely to be non-compliant. Different weights exist depending on whether the user is interested in the potential for "correct dosing" compliance (the percentage of days the correct number of doses were taken) or dose "taking" compliance (the percentage of prescribed doses taken).
Results
Survey respondents were 76.2% female, 86.2% Caucasian, with mean age 56.4 years. At the 90%, 80%, and 50% minimum thresholds for "correct dosing" compliance, 99.2%, 83.8% and 66.1% of patients were identified as potentially non-compliant respectively. The respective percentages for dose "taking" compliance, based on the same minimum thresholds, were 91.3%, 67.6% and 16.5% of patients.
Conclusions
Depending on desired compliance thresholds, at least 60% of self-reported RA patients demonstrate attributes identifying them as potentially non-compliant with treatment, based on taking the correct daily dose. Fewer patients were identified as potentially non-compliant based on taking the correct number of prescribed doses overall. This instrument may be useful in streaming patients into adherence programs, identifying appropriate patients for specific treatments or improving patient/physician discourse during shared decision making discussions. Future work should look at validating against other common adherence measures and fine tuning patient attributes most likely to lead to non-compliance.
References
de Klerk et al; Development of a Questionnaire to Investigate Patient Compliance with Antirheumatic Drug Therapy, 1999. The Journal of Rheumatology; v26(12): pp2635-41.v
Disclosure of Interest
M. Ingham Employee of: Janssen Scientific Affairs, LLC, S. Bolge Employee of: Janssen Scientific Affairs, LLC, L. Kopenhafer Consultant for: Janssen Scientific Affairs, LLC
Oral dabigatran was recently approved as an alternative to warfarin for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Unlike warfarin, dabigatran has a fixed dosage and few drug interactions, and does not require anticoagulation monitoring or dietary restrictions.This study aimed to describe and compare characteristics of patients with atrial fibrillation who used dabigatran or only warfarin. Patients with a self-reported diagnosis of atrial fibrillation aged ≥18 years who were receiving (or had received) warfarin or dabigatran completed an online survey. Differences in characteristics of dabigatran and warfarin users were tested using chi-squared tests and analysis of variance for categorical and continuous variables, respectively.Overall, 364 patients were surveyed (204 warfarin users, 160 dabigatran users). The mean age was 65.1 years, and 68.7% were male. Dabigatran users were more likely than warfarin users to be female (36.9% versus 27.0%) and to have experienced adverse events, including gastrointestinal bleeding, in the 3 months before the survey (21.9% versus 6.9%; P<0.05). Both groups reported high medication adherence (dabigatran users 0.65 versus warfarin users 0.63 missed doses/month). Dabigatran users were more likely than warfarin users to discuss treatment options with their physician before beginning therapy (36.9% versus 24.5%; P<0.05) and less likely to switch anticoagulant medication (10.7% versus 31.9%; P<0.05). Although dabigatran users were more likely to experience adverse events, they reported greater satisfaction with anticoagulation treatment than warfarin users.The efficacy and convenience reported by dabigatran users resulted in greater treatment satisfaction among dabigatran users, even though adverse events decreased it. Treatment strategies that minimize adverse events may improve treatment satisfaction and adherence among patients with atrial fibrillation.
Nitrovasodilators (NVs) are commonly recommended for the treatment of acute heart failure (AHF); however, registries suggest their use is not common. The objectives of this study were to determine patient characteristics associated with NV use and to explore the association between NV use and outcomes [length of stay (LoS) and inpatient mortality] in patients with AHF. A survey of US physicians (n = 426) who treat at least 5 AHF patients per month with NV provided a patient sample (n = 812 treated with NV and n = 322 not-NV) derived from chart review. Factors associated with NV use as well as patient characteristics and outcomes associated with NV use were explored using bivariate analysis, logistic regression, and negative binomial regression as appropriate. NV-treated patients were more likely to be female, have a higher systolic blood pressure, higher B-type natriuretic peptide and troponin, and stay in the intensive care unit while hospitalized, but less likely to be hyponatremic or hospitalized once previously. Overall, average LoS was 5.10 days (SD = 4.52) with 5.21 days (SD = 0.15) for the NV group and 4.94 days (SD = 0.31) for the non-NV group. The overall inpatient mortality rate was 2.1%. Among physicians who frequently use NV to treat AHF patients, there are distinct patient characteristics between NV treated and nontreated patients, suggesting a phenotype-driven approach. However, no differences in LoS or mortality were observed.
BACKGROUND: In 2010 and 2011, U.S. atrial fibrillation (AF) patients had two choices for oral anticoagulation therapy. However, limited real world data exist as to the patient characteristics, usage patterns, and medication perceptions of patients on these newer treatments. OBJECTIVE: To describe and compare characteristics of AF patients who have used warfarin or the newer anticoagulant, dabigatran. METHODS: Patient surveys were conducted via phone or internet from September 2011 to November 2011. Study patients were ≥18 years old, had a diagnosis of AF, and have used either warfarin or the newer anticoagulant, dabigatran. Characteristics differences were tested using chi-squared and ANOVA for categorical and continuous variables, respectively. RESULTS: We surveyed 361 patients. Of those, 204 were warfarin users and 160 were newer anticoagulant users (NAU). Mean patient age was 65.1. Patients were predominantly male (68.7%) and non-Hispanic white (91.2%). Nearly half (44.0%) of patients were obese and more than half (58.0%) had a Charlson Comorbidity Index (CCI) of ≥1. Average number of years with an AF diagnosis was 7. Patients were taking 6.26 medications on average. NAU were more likely to be female (36.9% vs. 27.0%), younger (60.93 vs. 68.36 years), diagnosed more recently (5.78 vs. 8.10 years), and had more education compared to warfarin patients (all p<.05). Levels of obesity (31.9% vs. 53.4%) and CCI burden of ≥1 (51.9% vs. 62.7%) were lower among NAU (p<.05). NAU were more likely to use an OTC medication (38.7% vs. 12.1%) or both a prescription and OTC medication (11.3% vs. 4.3%) to treat stomach-related symptoms (p<.05). NAU were more likely to have had a discussion about their treatment options with their physicians (36.9% vs. 24.5%) rather than have their physician prescribing (60.6% vs. 73.5%) (p<.05). NAU were significantly less likely to have considered switching their medication (10.7% vs. 31.9%). Among those considered switching, cost (62.5%) and insurance coverage (18.8%) were the most common reasons for NAU, and inconvenience factors (“too much of a hassle”; 19.5% and “interfering with my lifestyle”; 12.2%) for warfarin users. CONCLUSIONS: There were some characteristic differences among AF patients. Understanding patients' characteristics may be the first step in helping patients to be adherent to their stroke prevention medications.
