Medication Beliefs Regarding P2Y12 Inhibitors: An Exploratory Thematic and Semantic Analysis to Better Understand the Key Barriers to Medication Adherence.

Background Nonadherence to P2Y12 inhibitor therapy following percutaneous coronary intervention (PCI) is associated with an increased risk of major adverse cardiovascular events. However, there are a variety of factors - intentional and non-intentional - that contribute to P2Y12 inhibitor nonadherence and result in poor patient outcomes. Objective The primary aim of this study was to identify natural, lived experiences of individuals taking P2Y12 inhibitors in the real world, using a widely used social media platform to identify common barriers to medication adherence.  Methods Using deidentified data extracted from Twitter (now known as X) from January 1, 2016, to December 31, 2019, user comments pertaining to generic and brand names of P2Y12 inhibitor use were extracted using the GetOldTweets API (Application Programming Interface) with Python. Non-English tweets, duplicates, posts from automated bots, and those from users with clinical titles were excluded. The remaining posts were then manually reviewed based on the following inclusion criteria: (1) discussed treatment with P2Y12 inhibitors, (2) reflected personal experiences with P2Y12 inhibitors (e.g., patient or caregiver), and (3) provided sufficient context for qualitative analysis. A total of 366 eligible posts were analyzed using conventional content analysis and grouped into five key themes, which were further categorized into positive, negative, or neutral sentiments. Results Five representative themes emerged from the data, including adverse drug reactions (137 or 37%), affordability (93 or 25%), inconvenience of taking the medication (77 or 21%), patient-perceived response to treatment (42 or 12%), and provider trust and communication (17 or 5%). Most posts (205 or 56%) expressed negative sentiments (e.g., anger, frustration, sadness, fear) about taking P2Y12 inhibitors, while 26 (7%) shared positive sentiments (e.g., joy, gratitude, happiness, excitement). The remaining 135 (37%) were classified as neutral.  Conclusions This study, using natural, lived experiences of users with P2Y12 inhibitors, highlights the complex factors that may contribute to nonadherence to this medication. By better understanding patient attitudes and beliefs regarding this class of medication, as expressed in user comments, barriers to adherence can be identified and form the basis for future studies aimed at developing meaningful interventions to ensure consistent P2Y12 inhibitor use among post-PCI patients.