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      Cumplimiento terapéutico en pacientes en tratamiento con anticoagulantes orales en Atención Primaria Translated title: Therapeutic compliance in patients being treated with oral anticoagulants in Primary Care

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          Abstract

          RESUMEN Objetivo: evaluar y comparar el cumplimiento terapéutico entre los diferentes anticoagulantes orales. Diseño: estudio descriptivo transversal. Emplazamiento: Atención Primaria. Zona Básica de Salud de Bargas. Participantes: se incluyó a pacientes que llevasen más de 6 meses en tratamiento con anticoagulantes orales, pertenecientes a seis cupos de Medicina Familiar. Se excluyó a pacientes desplazados, incapaces de tomar la medicación de forma autónoma, ingresados o fallecidos durante el estudio. Mediciones principales: las variables estudiadas fueron: edad, sexo, nivel educativo, unidad familiar, tiempo de tratamiento, tipo de anticoagulante, efectos secundarios, polimedicación, tipo de receta, educación para la salud y cumplimiento terapéutico. Se realizó estadística descriptiva y analítica. Resultados: se evaluaron 110 pacientes con una edad media de 73,02 (desviación estándar [DE]: 12,06) años. Un 29,1% en tratamiento con anticoagulantes orales de acción directa (ACOD). La mediana de tiempo de tratamiento fue de 47 meses (rango intercuartílico: 16-77,25), el 84,5% eran polimedicados (7,36 ± 3,96 fármacos de media). Fueron cumplidores en total el 81,81% (intervalo de confianza [IC] 95% 73,32-88,52%). El 93,75% fue cumplidor con ACOD (IC 95% 79,19-99,23%) frente al 76,92% con acenocumarol (IC 95% 66,00-85,71%) (p = 0,055). El cumplimiento en polimedicados fue del 86%, frente al 58,8% en no polimedicados (p = 0,02). Conclusión: Nuestro estudio ha mostrado una aparente mayor adherencia terapéutica en los pacientes tratados con ACODs con respecto a los tratados con acenocumarol. La adherencia al tratamiento es mayor en los pacientes polimedicados.

          Translated abstract

          ABSTRACT Aim: To evaluate and compare treatment compliance among different oral anticoagulants. Design: Transversal descriptive study. Location: Primary Care. Bargas Basic Healthcare Area. Participants: Patients in treatment with oral anticoagulants more than 6 months who belonged to six Family Medicine quotas were included. Displaced patients, those unable to take medication autonomously, admitted to hospital or who died during the study were excluded. Primary endpoints: The variables studied were: age, sex, educational level, family unit, treatment time, type of anticoagulant, side effects, polymedication, type of prescription, education for health and treatment compliance. Descriptive statistics and analysis were performed. Results: 110 patients with a mean age of 73.02 (SD: 12.06) years old were studied. A total of 29.1% were in treatment with oral anticoagulants (OACs). Median treatment time was 47 months (interquartile range: 16-77.25). A total of 84.5% were polymedicated (7.36±3.96 drugs on average). In total 81.81% (95%CI 73.32-88.52%) were compliant. A total of 93.75% complied with OACs (95%CI 79.19-99.23%) compared to 76.92% with acenocumarol (95%CI 66.00-85.71%) (p=0.055). Compliance in polymedicated patients was 86% compared to 58.8% in non-polymedicated patients (p=0.02). Conclusion: Our study revealed an apparent greater treatment adherence in patients treated with OACs in regard to those treated with acenocumarol. Treatment adherence is greater in polymedicated patients.

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          What is polypharmacy? A systematic review of definitions

          Background Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. Methods The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). Results A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Conclusions Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.
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            Non-vitamin K antagonist oral anticoagulants: considerations on once- vs. twice-daily regimens and their potential impact on medication adherence.

            Suboptimal medication adherence is a widespread problem in ambulatory care of chronic diseases, with deviations in either direction from the prescribed dosing regimen. For the non-vitamin K antagonist oral anticoagulants (NOACs), such deviations occur and can lead to bleeding or clotting, as suboptimal adherence involves temporary periods of either overdosing or underdosing. In this expert review, we discuss: (a) the proper definition of adherence in terms of its three elements: initiation, implementation, and discontinuation; (b) how adherence is reliably and accurately measured and (c) successfully enhanced, to achieve and maintain safe and effective levels of NOAC-based anticoagulation. We also discuss the comparative effects of prescribing the same total daily dose, given either once-daily or as half-strength twice-daily doses. Because NOACs have plasma half-lives of ∼12 h, the twice-daily dosing regimen is less prone than the once-daily dosing regimen to hazardously high peaks or hazardously low troughs in anticoagulant concentrations and associated actions. As in other fields of oral drug treatment, the continuity of drug action is greater with twice-daily than with once-daily dosing, despite the fact that a few more doses are skipped with twice-daily than with once-daily dosing. This paradox is explained by the disproportionately greater impact on drug action of skipping a once-daily than a twice-daily dose. Integration of these principles into real-world medication management is the next step in the improvement of oral anticoagulation.
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              Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study.

              There is a perception among physicians that lack of routine monitoring with non-vitamin K antagonist oral anticoagulants (NOACs) may lead to poor adherence to medication. We studied adherence during the first year of usage in a cohort of patients with newly diagnosed non-valvular atrial fibrillation (AF) started on the NOAC, dabigatran etexilate. Nationwide Danish patient and prescription purchase registries were used to identify newly diagnosed AF patients taking dabigatran, comorbidities, and refill patterns under a twice-daily, one pill regimen. Adherence was characterized among remaining users (N = 2960) after 1 year using the proportion of days covered (PDC), gap rates and restart rates. The overall 1-year PDC was 83.9%, with 76.8% of patients having a 1-year PDC in excess of 80%. Patients with a CHA2 DS2 -VASc score ≥ 2 were more adherent to medication regimes than patients with a CHA2 DS2 -VASc score of 1 (PDC ratio, 1.12; 95% confidence interval [CI], 1.08-1.17) and generally patients with higher morbidity showed more adherence. Patients with prior bleeding were not less adherent to medication regimes than patients with no prior bleeding (PDC ratio, 1.02; 95% CI, 0.98-1.06). The overall gap rate was 1.4 gaps per year. There were no clear tendencies in gap rates among subgroups, although patients with higher morbidity tended to have slightly more, but shorter, gap periods. More than 75% of patients were showed > 80% adherence to medication regimes during the first year. Patients with higher morbidity, including patients with a higher risk of stroke or bleeding, exhibited better adherence. This improvement may be attributable to more regular contact with the healthcare system. © 2015 International Society on Thrombosis and Haemostasis.
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                Author and article information

                Journal
                albacete
                Revista Clínica de Medicina de Familia
                Rev Clin Med Fam
                Sociedad Castellano-Manchega de Medicina de Familia y Comunitaria (Albacete, Castilla La Mancha, Spain )
                1699-695X
                2386-8201
                2021
                : 14
                : 1
                : 12-17
                Affiliations
                [1] Toledo orgnameZona Básica de Salud de Sonseca (
                [4] Toledo orgnameConsultorio de los Olivos España
                [5] orgnameUnidad Docente de Toledo España
                [3] Toledo orgnameConsultorio del Señorío de Illescas España
                [2] Toledo orgnameConsultorio de Mocejón España
                Article
                S1699-695X2021000100012 S1699-695X(21)01400100012
                8824a017-ebe8-4d2f-8759-5a1beb9b7017

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 16 December 2020
                : 16 January 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 6
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                SciELO Spain

                Categories
                Original Breve

                Anticoagulantes,Treatment Adherence and Compliance,Cumplimiento y Adherencia al Tratamiento,Atención Primaria de Salud,Anticoagulants,Primary Health Care

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