Younger age, male gender, employment status, and hospital pharmacy prescriptions were significantly associated with increased odds of DOAC non-adherence, with non-adherence occurring in 24.2% of Bronx patients on DOAC therapy.
Case-Control (n=938)
No
DOAC non-adherence is prevalent (24.2%) and significantly driven by younger age, male gender, employment status, and use of hospital pharmacies, highlighting specific targets for adherence interventions.
Effect estimate: OR 1.19 per 10-year decrease in age; OR 1.41 for male vs female; OR 1.92 for employed vs retired; OR 2.70 for hospital vs community/retail pharmacy prescribing (95% CI Age OR 1.19 (95% CI 1.03 to 1.37); Male OR 1.41 (95% CI 1.02 to 1.95); Employment OR 1.92 (95% CI 1.09 to 3.57); Hospital pharmacy OR 2.70 (95% CI 1.96 to 3.85))
Absolute Event Rate: 24.2% vs 75.8%
p-value: p=0.020 (age), p=0.039 (male), p=0.032 (employment), p=0.001 (pharmacy type)
Background Anticoagulation non-adherence is attributed to myriad factors in patient populations across the world. While direct oral anticoagulants (DOACs) have demonstrated several clinical advantages over other anticoagulant classes, non-adherence persists and the underlying contributors vary by geography. Objective Outline patient and system level factors involved in DOAC non-adherence in the Bronx. Methods This retrospective review used all available electronic medical records on patients receiving active DOAC therapy from primary care centres in the Bronx between 2017–2024. Adherent and non-adherent groups were determined by prescription fill status and provider documentation. The two groups were compared by age, gender, race, ethnicity, insurance type, diagnostic indication for DOAC, pharmacy type, employment status, number of comorbidities, number of home medications and primary language. Univariable and multivariable logistic regressions were applied between the groups and categories. P values <0.05 were deemed significant. Results The cohort had 938 patients with non-adherence reported in 227 (24.2%) patients. In multivariable logistic regression, non-adherence was more common in younger patients (OR 1.19, CI 1.03 to 1.37, p=0.020) and in males (OR 1.41, CI 1.02 to 1.95, p=0.039). It was also more frequent among patients prescribing from hospital pharmacies (OR 2.70, CI 1.96 to 3.85, p=0.001) and the employed versus retired (OR 1.92, CI 1.09 to 3.57, p=0.032). Non-adherence was borderline significant in Black Non-Hispanics versus White Non-Hispanics (OR 1.75, CI 0.98 to 3.24, p=0.065) and in White Hispanics versus White Non-Hispanics (OR 1.98, CI 0.89 to 4.43, p=0.095). It was also borderline significant in English primary speakers versus Spanish primary speakers (OR 1.64, CI 0.96 to 2.86, p=0.071). Conclusion DOAC non-adherence in the Bronx is significantly associated with patient age, gender, employment status and prescribing pharmacy type. Other factors investigated in this study had borderline significant or no significant association and warrant further investigation.
Khasnavis et al. (Thu,) conducted a case-control in Adults receiving direct oral anticoagulants (DOACs) for indications including deep vein thrombosis, pulmonary embolism, atrial fibrillation/flutter, and other hypercoagulable conditions in Bronx primary care centers (n=938). Direct oral anticoagulant therapy (DOACs) vs. Medication adherence versus non-adherence groups was evaluated on Non-adherence to DOAC therapy defined by pharmacy records and provider documentation of medication intake patterns (OR 1.19 per 10-year decrease in age; OR 1.41 for male vs female; OR 1.92 for employed vs retired; OR 2.70 for hospital vs community/retail pharmacy prescribing, 95% CI Age OR 1.19 (95% CI 1.03 to 1.37); Male OR 1.41 (95% CI 1.02 to 1.95); Employment OR 1.92 (95% CI 1.09 to 3.57); Hospital pharmacy OR 2.70 (95% CI 1.96 to 3.85), p=p=0.020 (age), p=0.039 (male), p=0.032 (employment), p=0.001 (pharmacy type)). Younger age, male gender, employment status, and hospital pharmacy prescriptions were significantly associated with increased odds of DOAC non-adherence, with non-adherence occurring in 24.2% of Bronx patients on DOAC therapy.