title: Pharmacy quality alliance measure: adherence to non-warfarin oral anticoagulant medications.
abstract: BACKGROUND
  The Pharmacy Quality Alliance (PQA) recently endorsed adherence to non-warfarin anticoagulant agents as a new performance measure, but the Medicare Part D Star Ratings program has not yet adopted the measure. The current study aims to assess the real-world adherence to medication of patients who used non-vitamin-K-antagonist oral anticoagulants (NOACs) based on the PQA's adherence measure.
  
  
  METHODS
  Healthcare claims from the Humana database during the year of 2013 were analyzed. Patients older than 18 with ≥2 dispensings of NOAC agents, at least 180 days apart between two NOAC dispensings in 2013 (a criterion to include chronic users), with ≥60 days of supply, and ≥180 days of continuous enrollment prior to the index NOAC were identified. The PQA measure on the index therapy was calculated as the percentage of patients who had a proportion of days covered (PDC) ≥0.8 during their follow-up.
  
  
  RESULTS
  A total of 9948 NOAC users (rivaroxaban: n = 4194, dabigatran: n = 5489, apixaban: n = 265) were identified. For rivaroxaban users, the proportion of patients with a PDC ≥0.8 (PQA measure) at 75.4% was significantly higher compared to dabigatran users (67.6%; P < 0.001) and higher compared to apixaban users (70.6%; P = 0.076). When allowing switches to other NOAC agents in the PQA measure, rivaroxaban users had a significantly higher PQA measure at 76.9% compared to both dabigatran (72.9%; P < 0.001) and apixaban (71.3%; P = 0.037) users. Multivariate logistic regression analyses corroborated the findings that rivaroxaban had a significantly higher adherence compared to the other NOAC agents.
  
  
  CONCLUSIONS
  Claims data may have contained inaccuracies, possible change in patterns over time, and the impossibility of knowing whether all supplied tablets were taken.
  
  
  CONCLUSIONS
  Based on the PQA's adherence measure, rivaroxaban users were found to have a higher adherence compared to dabigatran and apixaban users. Healthcare providers may want to consider the impact of anticoagulation selection on their ability to achieve quality metrics.
authors.affiliation: a a Janssen Scientific Affairs LLC , Raritan , NJ , USA.
authors.forename: Concetta
authors.initials: C
authors.lastname: Crivera
authors.affiliation: a a Janssen Scientific Affairs LLC , Raritan , NJ , USA.
authors.forename: Winnie W
authors.initials: WW
authors.lastname: Nelson
authors.affiliation: a a Janssen Scientific Affairs LLC , Raritan , NJ , USA.
authors.forename: Brahim
authors.initials: B
authors.lastname: Bookhart
authors.affiliation: b b Johnson & Johnson Health Care Systems , Raritan , NJ , USA.
authors.forename: Silas
authors.initials: S
authors.lastname: Martin
authors.affiliation: c c Groupe d'analyse Ltée , Montréal, QC , Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Germain
authors.affiliation: c c Groupe d'analyse Ltée , Montréal, QC , Canada.
authors.forename: François
authors.initials: F
authors.lastname: Laliberté
authors.affiliation: a a Janssen Scientific Affairs LLC , Raritan , NJ , USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schein
authors.affiliation: c c Groupe d'analyse Ltée , Montréal, QC , Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D000069604:Dabigatran / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services; D011720:Pyrazoles / Q000008:administration & dosage*; D011728:Pyridones / Q000008:administration & dosage*; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Anticoagulant; Medication adherence; Patient compliance; Pharmacy Quality Alliance