title: Evaluating the impact of public health notification: Duke clopidogrel experience.
abstract: BACKGROUND
  Provider and public health interventions in the late 2006 sought to change the duration of clopidogrel use after drug-eluting stent (DES) implantation. We evaluated whether public health interventions were associated with changes in patient-reported clopidogrel use among DES patients.
  
  
  RESULTS
  We used interrupted time analyses to evaluate trends in duration of patient-reported clopidogrel use before, during, and after public and provider interventions. We included patients with significant coronary artery disease receiving an intracoronary stent between April 2004 and December 2007 at a single tertiary care center. The center supplemented national and regulatory messaging regarding the role of clopidogrel after DES implantation with direct-to-patient and to-their-provider notifications in December 2006. The combination of public and provider direct notification was associated with significant changes in the percent of DES patients reporting clopidogrel use at 6 months (16.55% increase, P=0.010) and 12 months (15.33% increase, P=0.004), but no change at 24-month follow-up (4.64, P=0.295). During the same period, there was no change in the percent of bare-metal stent patients reporting clopidogrel use at 6-month (-3.73%, 0.654), 12-month (-5.98%, P=0.389), and 24-month follow-up (-5.16, P=0.708). Although mortality rates through 24 months seemed to decrease between the pre- and postintervention periods, these changes were not significant (DES, P=0.086; bare-metal stent, P=0.296).
  
  
  CONCLUSIONS
  The combination of national scientific and regulatory messaging supplemented by local, personal communications to DES patients and their primary healthcare providers was associated with a significant increase in patient-reported clopidogrel use.
authors.affiliation: Duke Clinical Research Institute and Duke Translational Medicine Institute, Duke University Medical Center, Durham, NC, USA. eric.eisenstein@duke.edu
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: Daniel
authors.initials: D
authors.lastname: Wojdyla
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D022126:Access to Information; D000368:Aged; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D004334:Drug Administration Schedule; D004346:Drug Information Services / Q000639:trends; D054855:Drug-Eluting Stents; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009657:North Carolina; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D040442:Public Health Informatics / Q000639:trends; D012042:Registries; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine