Prescription Delay Following Stent Implantation Is a Common and Deadly Problem — Physician’s First Watch

Medical News |
May 29, 2014

Prescription Delay Following Stent Implantation Is a Common and Deadly Problem

By Larry Husten

Edited by Susan Sadoughi, MD , and Lorenzo Di Francesco, MD, FACP, FHM

Patients frequently delay filling prescriptions for clopidogrel after receiving stents, putting themselves at increased risk for death or myocardial infarction in the subsequent months and years, according to a study in the Journal of the American Heart Association.

Researchers analyzed data from over 15,000 stent implantations in British Columbia from 2004 through 2006. Nearly a third of the patients did not fill their clopidogrel prescriptions within 3 days after hospital discharge. A delay of 3 or more days was associated with a twofold increase in the risk for death or readmission with MI at 2 years, regardless of whether patients received a drug-eluting or bare metal stent. The increased risk was most evident in the first 30 days.

Citing previous research, the authors note: "Interventions to enhance discharge planning, educate patients, simplify regulatory hurdles, and ensure early community pharmacy involvement all have the potential to improve early compliance with medications after hospital discharge and, ultimately, clinical outcomes."

Adapted from CardioExchange

Reader Comments (6)

Kay Fraser, Certified Pharmacy Technician Other, Retail pharmacy

Now that Plavix is generic - clopidogrel. 99% of all insurance pays for it. Only when it was brand name did it need a prior authorization. There is a newer drug available Effient it is brand only. It will require a prior authorization. If you have private insurance there are Co-Pay cards that can reduce your out of pocket cost. As a pharmacy tech, I wish that doctors knew what kind of insurance thier patients have and write prescriptions accordingly. State paid insurance will never pay for Brand only drugs, they will always need a prior auth. Or I will be calling for generic if possible.

Rukiya Shells-Chavers Physician, Family Medicine/General Practice

The insurance companies ( including state, federal/gov, and commercial) ALL also need to have this medication on formulary without any prior authorization or step edit needed. The delay at the pharmacy level is a significant factor in this overall problem as most patients cannot afford out of pocket costs If denied by insurance, regardless of how vital it is to start immediately.

JOHN AMATO Other, Cardiology

Hopefully, in the near ten years since this data, education has improved. It would be more meaninful to see a more up-to-date time period.

William Lewis Wexler, Esq.J.D. Other, Other, Brooklyn Heights, NY

This being the case, it is negligence approaching malpractice to discharge a patient without first filliing a perctiption for the needed medication and sending it home with the patient

Kwei Quartey MD Physician, Internal Medicine

The solution to delayed Rx filling is to be sure the medication is obtained by the patient well before surgery and brought to any post-op center, if applicable; or placed at the patient's home bedside with a bottle of water to start taking the medication immediately.

Rukiya Shells-Chavers FNPc Other Healthcare Professional, Family Medicine/General Practice

I agree as well it would be sensible to have the treating facilities discharge patient with a one week supply of the medication allowing them time to fill the prescription, and prevent a delay if there is formulary issues at the pharmacy level.

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