Clinician-patient discord: exploring differences in perspectives for discontinuing clopidogrel

Eur J Cardiovasc Nurs. 2011 Mar;10(1):50-5. doi: 10.1016/j.ejcnurse.2010.04.002. Epub 2010 May 21.

Abstract

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.

Aim: 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.

Findings: 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Attitude of Health Personnel
  • Attitude to Health
  • Clopidogrel
  • Communication
  • Comorbidity
  • Drug-Eluting Stents / psychology
  • Drug-Eluting Stents / statistics & numerical data
  • Female
  • Humans
  • Male
  • Medication Adherence / psychology*
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / psychology*
  • Myocardial Infarction / therapy
  • Patients / psychology
  • Physician-Patient Relations*
  • Physicians / psychology
  • Platelet Aggregation Inhibitors / therapeutic use
  • Qualitative Research
  • Thrombosis / epidemiology
  • Thrombosis / prevention & control
  • Thrombosis / psychology*
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / therapeutic use

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine