Effects of conflicting prescription drug information from direct-to-consumer advertising and drug injury advertising on patients' beliefs and medication adherence

BACKGROUND

Patients are often exposed to contradictory information about pharmaceutical products from various types of advertising. For example, direct-to-consumer advertising (DTCA) tend to emphasize a drug's benefits, while drug injury advertising emphasizes the worst side effects. Regarding DTCA as a drug information source, many researchers in pharmacy field focus on investigating the misinformation in DTCA and corrective advertising. However, no prior research has examined the effects of such contradictory advertising messages on patients' prescription medicine-related beliefs and medication adherence. This is a significant gap in the research literature on pharmaceutical advertising effects and medication adherence.

OBJECTIVE

This is aimed to examine how exposure to DTCA and drug injury advertising would influence patients' chronic accessibility of drug-related beliefs and their medication adherence behavior.

METHODS

An online survey was conducted with a sample of 213 patients taking prescription blood thinners.

RESULTS

The findings from this study did not support the predicted relationship between exposure to DTCA and consumers' drug-related belief accessibility or their medication adherence. However, this study found a significant interaction effect of exposure to DTCA and exposure to drug injury ads on patients' medication adherence. The analysis results demonstrate that, for those who were exposed to drug injury ads, a significant negative relationship emerged between DTCA exposure and medication adherence.

CONCLUSION

This study provides important empirical evidence of a negative interaction effect of exposure to DTCA and drug injury ads on patients' medication adherence, which demonstrates that the influence of DTCA and drug injury ad exposures on patients' medication adherence is not independent, separate process but an interactive process. A communication campaign with corrective advertising could alleviate the negative interaction effect of exposure to contradictory information from different types of pharmaceutical ads on patients' medication adherence.

Impact of Hospitalization and Medication Switching on Post-discharge Adherence to Oral Anticoagulants in Patients With Atrial Fibrillation

BACKGROUND

Adherence to chronic medications remains poor in practice. There is limited evidence on how hospitalization affects post-discharge adherence to oral anticoagulants (OACs) in individuals with atrial fibrillation. The aim of this study was to examine the impact of hospitalization and medication switching on post-discharge adherence to OACs in the population with atrial fibrillation.

METHODS

A quasi-experimental pre-post observational study was conducted using United States commercial insurance health care claims from the 2009 to 2016 Optum database. Adults with atrial fibrillation taking OACs who had a random hospitalization occurring after the first observed OAC prescription fill and no other admission in the preceding and following 6 months were identified. OAC adherence was estimated by the proportion of days covered within 6 and 12 months before and after hospitalization. Difference-in-difference analysis was employed to compare the pre-hospitalization and post-hospitalization proportion of days covered, stratified by reasons for hospitalization (i.e., bleeding vs non-bleeding-related reasons) and adjusting for imbalanced baseline characteristics between groups. Change in adherence when the OAC was switched at discharge was also examined.

RESULTS

The 22,429 individuals who met study criteria were predominantly male (52.4%), white (77.2%), and older age (median 74 years). A clinically significant hemorrhage was the reason for 1029 (4.5%) of qualifying hospitalizations. After covariate adjustment, there was a reduction in the proportion of days covered after discharge, regardless of admission diagnosis (p<0.0001). The 6-month difference-in-difference analyses revealed that adherence was incrementally reduced by 3.2% (p=0.0003) in the bleeding group compared with the nonbleeding group, whereas switching from warfarin to a direct oral anticoagulant after hospitalization was associated with a smaller reduction by 3.4% in adherence (p=0.0342) compared with other switchers, regardless of the reason for hospitalization. The 12-month difference-in-difference analyses revealed similar results.

CONCLUSIONS

Hospitalization is temporally associated with a reduction in adherence to OACs, regardless of reason for hospitalization. More effective strategies are needed to improve OAC adherence, particularly during transition of care.