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Circ Cardiovasc Qual Outcomes. 2012 Nov;5(6):767-74. doi: 10.1161/CIRCOUTCOMES.111.963330. Epub 2012 Oct 23.

Evaluating the impact of public health notification: Duke clopidogrel experience.

Author information

1
Duke Clinical Research Institute and Duke Translational Medicine Institute, Duke University Medical Center, Durham, NC, USA. eric.eisenstein@duke.edu

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.

METHODS AND 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.

PMID:
23093562
DOI:
10.1161/CIRCOUTCOMES.111.963330
[Indexed for MEDLINE]

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