This week there is a great item about diabetes and cardiovascular problems, especially in women. In fact there are a total of four items that continue to expound on the relationship between diabetes, obesity and cardiovascular Disease. To make matters worse, many patients who have had a heart attack and have had a stent put in don’t take their clopidogrel when they leave the hospital. A new study from Edinburgh Heart Centre, United Kingdom, finds that almost one in three patients fail to fill their prescription for clopidogrel within three days of hospital discharge after coronary stent implantation.
According to their study of over 15,000 stent-receiving patients those who delayed filling their first prescription for clopidogrel by at least three days after hospital discharge were older, more likely to have had an ST-elevation MI, and had more comorbid illnesses than their peers who filled the prescription within three days of discharge. This delay of more than three days was associated with a twofold or greater increased risk of death and recurrent MI, and the risk was greatest in the first 30 days after discharge.
As a pharmacist I could understand why these patients would often times not fill the prescription when it was an expensive brand name product. However now when the cost or copay is so low that no one should have an excuse not to fill it, we need to do a better job of getting our patients started. Electronic prescribing can help and having an explanation from the prescriber will go a long way. We could also improve patient adherence if pharmacists would do a better job of notifying patients to come and get these medications when they receive the prescription and explain why they need to continue.
Dave Joffe, Editor-in-chief