November 3rd, 2010
Do Your Patients Wait to Fill Their Plavix and Effient Prescriptions After Drug-Eluting Stent Implantation?
I recently read an article in the journal Circulation that contained an alarming finding about patients who receive drug-eluting stents. Apparently, 1 in 6 did not fill their clopidogrel prescriptions immediately after discharge from a hospital in one of three large integrated health care systems. The median delay was 3 days.
Furthermore, during a median follow-up of 22 months, the risk for death or myocardial infarction was significantly higher among patients with any delay in filling their clopidogrel prescriptions than among those with no delay (raw incidence, 14.2% vs. 7.9%). Many of the events occurred within 30 days after discharge, and adjustment for delays in filling prescriptions for other guideline-recommended therapies did not alter the findings.
A bit of research in our hospital’s database revealed that since January 2008, five of the 12 DES patients readmitted to the hospital with stent thrombosis within 30 days after discharge had delayed, stopped, or never filled their prescriptions for an ADP-receptor inhibitor. A frequently cited reason was the cost of the medication.
Our AMI team met to determine the best approach to increase adherence. We initially focused on how to get the meds. We found that the makers of Plavix (clopidogrel) and Effient (prasugrel) offer coupons for free 14- and 30-day supplies, respectively, via sales representatives. In addition, long-term prescription-related financial assistance for patients is available from both companies. We’re in the process of educating our case managers about these offerings. Click here to access the Plavix application from Bristol-Myers Squibb and the Effient application from Eli Lilly.
Our goal is to use our outpatient pharmacy to get all our acute coronary syndrome patients discharged with their prescriptions filled. We pulled together a multidisciplinary team of people from the cath lab, telemetry, case management, the pharmacy, and cardiac rehab. The team has begun to develop a protocol and step-by-step algorithm to help facilitate the implementation of our adherence program.
That said, we have already identified a couple of hurdles: (1) How do we ensure that patients actually walk out of the hospital with the medication in hand? (2) How, in the case of Plavix, do we finance the additional 16-days needed to provide a full 30-day supply?
We’d love to hear from any of you whose facilities have implemented or are contemplating the implementation of such a program.