Clinician-patient discord: exploring differences in perspectives for discontinuing clopidogrel.
BACKGROUND
Premature stopping of anti-platelet therapy has potentially fatal consequences for myocardial infarction (MI) patients who have received a drug-eluting stent (DES). Exploring multiple perspectives to identify contributing factors to the problem is essential.


OBJECTIVE
We gained patient and clinician perspectives as to why MI patients prematurely stop anti-platelet therapy (clopidogrel) after DES implantation.


METHODS
This qualitative, descriptive study of DES-treated MI patients (n=22) and of clinicians (physicians and nurse practitioners; n=17) from multiple U.S. cities used content analysis of interview data. Findings across patients and clinicians were then compared to examine congruent and contrasting reasons for premature clopidogrel discontinuance.


RESULTS
Patients frequently identified communication and education (e.g. unaware they should be taking clopidogrel, unaware of intended duration of therapy) as the primary reasons for having stopped. Patients rarely cited cost, while clinicians most commonly cited cost as a reason for premature stopping.


CONCLUSIONS
The discrepancy in perceptions of patients and clinicians as to the primary reason for early discontinuance suggests an important opportunity for improving persistence. Rather than focusing on the high costs of medications, something outside of their control, physicians should consider communicating more effectively the importance and intended duration of clopidogrel to their patients.
Garavalia
Linda
L
University of Missouri-Kansas City School of Pharmacy, USA.
Ho
P Michael
PM
Garavalia
Brian
B
Foody
JoAnne M
JM
Kruse
Heather
H
Spertus
John A
JA
Decker
Carole
C
D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D000077144:Clopidogrel; D003142:Communication; D015897:Comorbidity; D054855:Drug-Eluting Stents / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D036301:Qualitative Research; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016903:Drug Monitoring
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine