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Li PWC, Yu DSF, Yan BP. Nurse-led multi-component behavioural activation programme to improve health outcomes in patients with atrial fibrillation: a mixed-methods study and feasibility analysis. Eur J Cardiovasc Nurs 2023; 22:655-663. [PMID: 36394495 DOI: 10.1093/eurjcn/zvac104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 09/06/2023]
Abstract
AIMS Patients with atrial fibrillation (AF) play passive roles in disease management. This study aimed to examine the feasibility and preliminary effects of an empowerment-based care model, titled 'the nurse-led multi-component behavioural activation (N-MBA) programme', on health-related quality of life, AF knowledge, psychological outcomes, medication adherence, and treatment decision-making in patients with AF. METHODS AND RESULTS This mixed-methods study comprised a pilot randomized controlled trial and a qualitative study. Patients with AF who had a moderate-to-high risk of stroke but were not prescribed oral anticoagulants were recruited. Forty participants were recruited and randomized in a 1:1 ratio to receive either the N-MBA programme or standard care. The 13-week programme comprised care components that prepared patients for shared decision-making, an empowerment-based educational module on AF self-care, and continuous support through telephone calls. The programme was feasible, and the overall attendance rate was 82.5%. The participants gave excellent ratings in the satisfaction survey. The N-MBA group showed greater improvements in health-related quality of life (HRQoL) and AF knowledge than the standard care group at the immediate post intervention and 6-month follow-up time points. No significant between-group changes in medication adherence, anxiety, and depression were detected. Participants in the N-MBA group actively raised concerns about AF and its treatment with their attending doctors. The qualitative data were consistent with the quantitative data, indicating that the programme built a comprehensive knowledge base of AF and self-care behaviours. CONCLUSION The N-MBA programme is feasible and acceptable to patients with AF. It improved patients' AF knowledge, treatment-related decision-making, and HRQoL. REGISTRATION ClinicalTrials.gov NCT03924739.
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Affiliation(s)
- Polly W C Li
- School of Nursing, LKS Faculty of Medicine, 5/F, HKUMed Academic Building, 3 Sassoon Road, The University of Hong Kong, Pokfulam, Hong Kong
| | - Doris S F Yu
- School of Nursing, LKS Faculty of Medicine, 5/F, HKUMed Academic Building, 3 Sassoon Road, The University of Hong Kong, Pokfulam, Hong Kong
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Praxedes MFDS, da Silva JLP, da Cruz AJA, Viana CC, Barbosa HC, Guimarães NS, Martins MAP. Assessment of the relationship between the level of patient knowledge on warfarin therapy and the quality of oral anticoagulation: A systematic review and meta-analysis. PLoS One 2023; 18:e0289836. [PMID: 37561771 PMCID: PMC10414645 DOI: 10.1371/journal.pone.0289836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
The present study aimed to investigate the relationship between the level of patient knowledge on warfarin therapy and the quality of oral anticoagulation. This is a systematic review and meta-analysis written on the basis of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Searches at MEDLINE, EMBASE, Scopus and LILACS electronic databases were carried out on February 13, 2023, using the descriptors "Patient Medication Knowledge", "Patient Education as Topic", "Health Education", "Patient Education" and Warfarin. The steps of selection, data extraction and quality analysis of articles were performed independently by two reviewers. The analysis was performed considering patient knowledge as a possible modifier of time in therapeutic range (TTR). The meta-analysis included studies that reported the correlation coefficient (Pearson or Spearman) between patient knowledge and TTR. A subgroup analysis was performed according to questionnaires employed to measure patient knowledge. Twelve studies were selected with an overall sample size of 7634 participants and mean age 58.2 (standard deviation (SD)±12,8) years. Eleven (92.0%) cross-sectional studies. The mean TTR was 57.8% (SD±11,3%) and the average level of knowledge was 60.4%. The meta-analysis indicated that patient level of knowledge on warfarin therapy was moderately associated with TTR (rs = 0.435; 95% confidence interval (CI) = 0.163-0.645; I2 = 96%). Subgroup analysis indicated association between knowledge level and TTR in studies employing the OAK test (rs = 0.617; 95% CI = 0.192-0.847; I2 = 97%) and the AKA (rs = 0.269; 95% CI = 0.002 to 0.501; I2 = 94%). However, the subgroup analysis presented no significant difference between them (p = 0.14). The meta-regression showed a non-significant negative effect of age on the correlation (estimate = -0.028, 95% CI = -0.073 to 0.016, p = 0.207). No publication bias was noted (p = 0.881). To our knowledge, this is the first systematic review and meta-analysis gathering evidence about the relationship between the level of patient knowledge on oral anticoagulation with warfarin and TTR. The implementation of structured and patient-centered educational interventions is essential to effectively increase the level of patient knowledge and, thus, to improve the quality and safety of warfarin therapy. Systematic review registration number: PROSPERO CRD42023398030.
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Affiliation(s)
| | | | | | - Catiane Costa Viana
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Patient Education Strategies to Improve Risk of Stroke in Patients with Atrial Fibrillation. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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4
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Ehsani M, Farahani MA, Haghani S, Khaleghparast S, Memar MM. Assessment of knowledge and practice of cardiovascular nurses regarding warfarin. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:270. [PMID: 36325219 PMCID: PMC9621373 DOI: 10.4103/jehp.jehp_1240_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/22/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Despite new anticoagulants' developments, warfarin is still one of the most commonly used medicines, particularly in the cardiovascular system. One of the significant challenges with warfarin is the prevalence of dangerous side effects such as bleeding and drug and food interactions, which can negatively affect patients if not adequately controlled. As health-care team members, nurses have a crucial role in prescribing this medicine and educating patients. In this regard, this study was conducted to determine the knowledge and practice of nurses working in the cardiovascular wards regarding warfarin. MATERIALS AND METHODS In this cross-sectional, descriptive study, knowledge and practice of 239 nurses working in the cardiovascular wards of teaching hospitals affiliated to Iran University of Medical Sciences have been investigated using European Cardiovascular Nurses Knowledge questionnaire on anticoagulants and the checklist for high-risk drugs safety instructions. The sampling was performed through the stratified sampling method with proportional allocation. Data were analyzed using the SPSS software version 16 through descriptive and inferential statistics (independent t-test, one-way analysis of variance, and Pearson correlation coefficient) (Inc., Chicago, IL, USA). RESULTS The mean scores of knowledge (18.51 ± 3.87) and practice (10.53 ± 2.12) were slightly higher than the median, and the lowest mean score was related to knowledge on drug interactions (7.62). The practice had a statistically significant relationship with knowledge (P < 0.001). Regarding demographic variables, there was a statistically significant relationship between nurses' knowledge and the education level (P = 0.009) and nurses' practice and age (P = 0.022), work experience (P = 0.032), and work experience in cardiovascular wards (P = 0.036). CONCLUSIONS Based on the findings of this study, the knowledge of nurses working in the cardiovascular wards about warfarin was not sufficient, and their practice was of poor quality. Nurses' lack of knowledge and improper practice can jeopardize drug safety in patients and cause serious side effects such as bleeding. Proper training of nursing students and nurses about warfarin as a high-risk drug, its side effects, and drug-food interactions, and the emphasis on patient education in patients receiving this medicine can effectively reduce the incidence of side effects.
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Affiliation(s)
- Maryam Ehsani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Ashghali Farahani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Shiva Khaleghparast
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Jang I. A Systematic Review on Mobile Health Applications' Education Program for Patients Taking Oral Anticoagulants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178902. [PMID: 34501492 PMCID: PMC8430962 DOI: 10.3390/ijerph18178902] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
Warfarin is widely used as an oral anticoagulant. However, it is difficult to manage patients due to its narrow therapeutic range and individualized differences. Using controlled trials and real-world observational studies, this systematic review aimed to analyze health education’s impact among patients on warfarin therapy by mobile application. Smartphone and tablet applications have the potential to actively educate patients by providing them with timely information through push notifications. MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane electronic databases were searched using the keywords “anticoagulants,” “warfarin”, “mobile application”, and “smartphone” up to May 2020. Of the 414 articles obtained, 12 articles met the inclusion criteria for this review. The education and self-management programs using the mobile health application had diverse contents. A meta-analysis was not deemed appropriate because of the heterogeneity of populations, interventions, and outcomes. Thus, a narrative synthesis is presented instead. This review demonstrates that educating patients for anticoagulation management through their smartphones or tablets improves their knowledge levels, medication or treatment adherence, satisfaction, and clinical outcomes. Moreover, it has a positive effect on continuing health care. Future research concerning patients taking warfarin should include key self-management outcomes in larger, more rigorously designed studies, allowing for comparisons across studies. This study proposes a continuous application of timely education through smartphone applications to the current medical and nursing practice.
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Affiliation(s)
- Insil Jang
- Department of Nursing, Chung-Ang University, Seoul 06974, Korea
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6
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Beyene K, Chan AHY, Näslund P, Harrison J. Patient-related factors associated with oral anticoagulation control: a population-based cohort study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:443-450. [PMID: 34302345 DOI: 10.1093/ijpp/riab041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 06/28/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Time in therapeutic range (TTR) of ≥70% is a commonly used indicator of optimal anticoagulation control. This study aimed to determine the patterns and predictors of anticoagulation control in a population-based cohort of new users of warfarin. METHODS This was a retrospective cohort study. All adults (age ≥18 years) who had been newly initiated on warfarin therapy between January 2006 and March 2011were selected from administrative health databases. TTR was calculated using the Rosendaal method. Multivariable logistic regression models were used to identify patient-related factors associated with optimal TTR. Predictors of patients spending >30% of time above and below the therapeutic international normalised ratio (INR) range were also examined. KEY FINDINGS A total of 6032 patients were included in this study. The mean TTR was 54.1 ± 18.8%, and 82.3% of patients had subthreshold TTR (<70%). Compared with New Zealand Europeans, Māori and Pacific people had decreased odds of achieving optimal TTR and increased odds of spending >30% of time below the therapeutic INR range. Patients aged 65-74 years and 75 years or older had increased odds of achieving optimal TTR but decreased odds of spending >30% of time below the therapeutic INR range than those <65 years. Compared with those living in the least socioeconomically deprived areas, those living in the most deprived areas had decreased odds of achieving optimal TTR. CONCLUSIONS Anticoagulation control with warfarin is suboptimal in routine care in New Zealand. Age, ethnicity and deprivation index were significant predictors of TTR. It is important to ensure equitable access to appropriate, high-quality care for those living in deprived areas and those from ethnic minority groups.
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Affiliation(s)
- Kebede Beyene
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Patricia Näslund
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Jeff Harrison
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
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7
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Jiang S, He Q, Yan J, Zhao L, Zheng Y, Chen P, Chen X. Evaluation of a Pharmacist-Led Remote Warfarin Management Model Using a Smartphone Application (Yixing) in Improving Patients' Knowledge and Outcomes of Anticoagulation Therapy. Front Pharmacol 2021; 12:677943. [PMID: 34276368 PMCID: PMC8281133 DOI: 10.3389/fphar.2021.677943] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/21/2021] [Indexed: 01/17/2023] Open
Abstract
Background: The management of warfarin-treated patients has been recognized as a challenge due to narrow therapeutic range and food and drug interactions in warfarin therapy. We aim to evaluate the effect of a pharmacist-led remote warfarin management model using a smartphone application (app) on anticoagulation therapy. Methods: Eligible patients who had received warfarin therapy after mechanical heart valve replacement were enrolled. The intervention group was offered a pharmacist-led remote warfarin management model using the app named Yixing. Yixing incorporates functions including automatic daily reminder, personal health record, educational program, and online counseling. The control group received traditional pharmacy services without Yixing. Co-primary outcomes were patients’ awareness score of warfarin therapy obtained from questionnaire, the medication adherence measured by the percentage of the correct-warfarin-taken days in the monitored period, the fraction of time in therapeutic range (FTTR), and the incidence of anticoagulation-related complications. The needed information of the patients was acquired via electronic medical records from the hospital, Yixing system and telephone follow-up when necessary. Results: 64 and 66 patients were initially in the intervention and control groups respectively. After propensity score matching, 50 patients were assigned in each group. The intervention group had a median age of 51.0 years, in which 27 (54%) were male. The control group had a median age of 50.5 years, in which 28 (56%) were male. Patient awareness score in the intervention group was 8.00 (2.00), which was higher than that in the control group, with score at 6.50 (2.50) (p = 0.001). No significant difference was found in the percentage of the correct-warfarin-taken days between the two groups (p = 0.520). The median (interquartile range) value of FTTR was 80.3% (21.9%) and 72.1% (17.7%) in the intervention and control groups respectively (p = 0.033), and no significant differences in the incidence of anticoagulation-related complications were observed (p = 0.514). Conclusion: The pharmacist-led remote warfarin management model using Yixing improves patients’ awareness of warfarin therapy and increases FTTR, but may not have significant improvements on medication adherence and safety.
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Affiliation(s)
- Shudan Jiang
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Department of Pharmacy, The Maternal and Child Health Care Hospital of HuaDu District (Huzhong Hospital), Guangzhou, China
| | - Qiuyi He
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiajia Yan
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liyan Zhao
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yifan Zheng
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Pan Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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8
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Showande SJ, Orok EN. Impact of pharmacists' training on oral anticoagulant counseling: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2021; 104:1253-1259. [PMID: 32998837 DOI: 10.1016/j.pec.2020.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The study evaluated the impact of oral anticoagulant counseling training on the quality of counseling provided by pharmacists. METHODS A prospective RCT was conducted among 33 pharmacists from 23 pharmacies in Ibadan, Nigeria. Six mystery patients (MPs) who were either warfarin-naïve, experienced adverse drug reaction (ADR), or drug interaction (DI) to warfarin were used to assess pharmacists' oral anticoagulant counseling quality at pre- and post-intervention. A 2-week online oral anticoagulant counseling training was given to the intervention group pharmacists. Quality of counseling was categorized as poor (0-20 %), fair (21-50 %), moderate (51-80 %), and optimal (81-100 %). RESULTS At pre-intervention, the quality of oral anticoagulant counseling provided to the MPs was poor. Post-intervention, the quality improved among pharmacists in the intervention group, from poor to fair for both warfarin-naïve MP and MP who experienced DI, and from fair to moderate for MP with ADR. CONCLUSION Short-term online oral anticoagulant counseling training improved the quality of counseling provided by community pharmacists to mystery patients on warfarin. PRACTICE IMPLICATION Online oral anticoagulant counseling training may be employed by pharmacists' professional bodies intermittently to improve oral anticoagulant counseling.
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Affiliation(s)
- Segun J Showande
- Department of Clinical Pharmacy and Pharmacy Administration, University of Ibadan, Ibadan, Nigeria.
| | - Edidiong N Orok
- Department of Clinical Pharmacy and Pharmacy Administration, University of Ibadan, Ibadan, Nigeria
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Lo FMW, Wong EML, Hong FKW. The Effects of Educational Programs on Knowledge, International Normalized Ratio, Warfarin Adherence, and Warfarin-Related Complications in Patients Receiving Warfarin Therapy: An Integrative Review. J Cardiovasc Nurs 2021; 37:E32-E46. [PMID: 33657063 DOI: 10.1097/jcn.0000000000000790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Education is considered a crucial element in anticoagulation management for patients with atrial fibrillation, valvular disease, ischemic heart disease, and venous thromboembolism. However, the effects of education on the patients prescribed warfarin are seldom investigated. OBJECTIVES This integrative review was conducted to explore the effects of educational programs on patients prescribed warfarin for the aforementioned cardiovascular diseases and to identify the components of effective programs. METHODS A systematic search of clinical trials was performed in 8 databases from inception to August 2020. Two reviewers performed the eligibility assessment, methodological evaluation, and data extraction. A total of 9 studies were included and analyzed via narrative synthesis. RESULTS Nine studies involving a combined total of 1335 patients were included in the review. The findings suggest that educational programs have potential benefits related to international normalized ratio control and warfarin knowledge. However, their effects on major bleeding and thromboembolic events are unremarkable. Stronger evidence is recommended to confirm these findings, and the limited evidence examining the effects of education on warfarin adherence, minor bleeding, abnormal international normalized ratio, readmission rate, and warfarin-related mortality requires further exploration. Verbal education supported by written materials was the main educational delivery mode. A lecture length of approximately 45 minutes was likely appropriate. Notably, the integration of educational strategies, application of follow-up interventions and monitoring measures, adoption of psychological theories in program development, and inclusion of nurses or pharmacists in program conduction seemed to be effective program components. CONCLUSIONS The effects of educational programs on patients prescribed warfarin mainly for atrial fibrillation, valvular disease, ischemic heart disease, and venous thromboembolism remain inconclusive. Further research using randomized controlled trials is warranted.
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Affiliation(s)
- Flora M W Lo
- Flora M. W. Lo, MN Student, Doctor of Health Science, The Hong Kong Polytechnic University, Hong Kong. Eliza M. L. Wong, PhD Principal Research Fellow, School of Nursing, The Hong Kong Polytechnic University, Hong Kong. Felix K. W. Hong, MN Nurse, Nursing Department, Kiang Wu Hospital, Macao, China
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10
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Ahmed H, Saddouh EA, Abugrin ME, Ali AMM, Elgdhafi EO, Khaled A, Tarek A, Elhadi M. Association between Patients' Knowledge and Adherence to Anticoagulants, and Its Effect on Coagulation Control. Pharmacology 2020; 106:265-274. [PMID: 33202413 DOI: 10.1159/000511754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Warfarin requires strict monitoring by measuring prothrombin time (PT), international normalized ratio (INR), and time in therapeutic range (TTR). Several factors can lead to poor PT/INR control including vitamin K status, medication adherence, knowledge, and quality of life. The present study aims to assess patient adherence to warfarin treatment and its correlation with INR control. METHODS A cross-sectional study was conducted between October 2017 and January 2018 at Tripoli University Hospital. Data were collected by structured questionnaires which included; demographic and clinical characteristics, the Oral Anticoagulation Knowledge (OAK) test, and the Morisky Medication Adherence Scale (MMAS-8). RESULTS The final analysis included 88 out of 140 patients (73.33%). There were significant differences in age range, gender, marital status, and education level between the 2 groups (poor knowledge and adequate knowledge) (p < 0.05). There was a significant positive correlation between OAK test score and TTR. Overall, 76.2% of patients were adherent to warfarin (MMAS score ≥6) and 20.45% of patients were of high adherence (MMAS score of 8). The median score was 6 (IQR 6-7). A statistically significant, strong positive correlation between adherence to medication and TTR as an indicator of INR control was found (rs[86] = 0.472, p < 0.0001). CONCLUSION The study addressed and identified several areas for future improvement of patient outcomes. The implementation of new approaches to enhance patient knowledge and adherence is warranted, and measures to provide treatment for all patients that require it are needed, to improve outcomes and decrease adverse drug effects.
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Affiliation(s)
- Hazem Ahmed
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | | | - Ala Khaled
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Ahmed Tarek
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
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11
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Fariborz Farsad B, Dastan F, Salamzadeh J, Moghadamnia Z, Eskandari R, Fahimi F. Assessment of Outpatients' Knowledge and Adherence on Warfarin: The Impact of a Simple Educational Pamphlet. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2020; 18:315-320. [PMID: 32802110 PMCID: PMC7393044 DOI: 10.22037/ijpr.2020.14766.12641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Warfarin is a critical medication that is broadly used for the treatment and prevention of thromboembolic disorders. Due to warfarin’s narrow therapeutic index, it is crucial that patients follow an appropriate dosage regimen. Patient knowledge is one of the most important factors to safe and effective use of warfarin. Due to the obvious risks of anticoagulants administration, evaluating patients’ awareness seems to be crucial. The purpose of this article was to evaluate the effects of intervention by an informative pamphlet on knowledge and adherence of patients who consumed warfarin. Two-hundred and fifty patients receiving warfarin were assigned to the study. They were asked to fill in the questionnaire. Then patients were provided with an educational pamphlet. In the second interview, patients filled the questionnaire again. Obtained data were assessed and analyzed by Excel software and SPSS version 18.0. Out of 250 patients who entered the study, 150 patients attended for the second interview. Data analysis revealed that out of 13 explanatory factors, only patients’ literacy level and income were the predictors which inversely correlated with the patients’ adherence (r = -0.44; p = 0.00040). Our educational intervention had a positive impact on patients’ knowledge regarding anticoagulation (p < 0.0001). Our findings revealed that a written informative pamphlet could effectively increase patients’ anticoagulation knowledge. Since, poorly literate patients had a lesser level of knowledge before and after educational intervention, it is recommended to develop appropriate educational programs especially designed for this group of patients.
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Affiliation(s)
- Bahram Fariborz Farsad
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Dastan
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamshid Salamzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Food Safety Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Moghadamnia
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Raha Eskandari
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fanak Fahimi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Zahid I, Ul Hassan SW, Bhurya NS, Alam SN, Hasan CA, Shah BH, Fatima FB, Ahmed A, Ul Hassan SS, Hayat J, Zulfiqar A, Sheikh R, Aziz M, Siddiqi R, Fatima K, Khan MS. Are patients on oral anticoagulation therapy aware of its effects? A cross-sectional study from Karachi, Pakistan. BMC Res Notes 2020; 13:279. [PMID: 32517741 PMCID: PMC7285618 DOI: 10.1186/s13104-020-05119-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Oral anticoagulants are one of the most frequently used medications. However, these drugs have a range of side effects including potential life-threatening complications. Little is known regarding the awareness of its side effect profile amongst the patients in Pakistan. Therefore, the aim of this study was to assess the knowledge of oral anticoagulant therapy and its side effects among its users. Results The mean age was 48.9 ± 15.2 years. Median scores of the participants for knowledge regarding oral anticoagulants and warfarin were 48.7 (8.3–91.7) and 10.3 (0.0–70.0) respectively. Of 207 patients, most notably, 65.7% did not know what side effects to be wary of or how to reduce their occurrence; and most patients were unaware of the interaction between oral anticoagulant drugs and over-the-counter substances such as aspirin, herbal medicines and alcohol. Knowledge of international normalised ratio (INR) was extremely poor with more than 75% of the population not being aware of the target INR range during warfarin therapy. Higher level of education was significantly associated with better knowledge scores. Overall, knowledge of oral anticoagulant therapy and INR monitoring is extremely poor among oral anticoagulant users.
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Affiliation(s)
- Ibrahim Zahid
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | | | | | | | - Bakht Hussain Shah
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ayesha Ahmed
- Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan
| | | | - Javeria Hayat
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Aqsa Zulfiqar
- Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan
| | - Rija Sheikh
- Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan
| | - Momin Aziz
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabbia Siddiqi
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Kaneez Fatima
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Metaxas C, Albert V, Habegger S, Messerli M, Hersberger KE, Arnet I. Patient Knowledge about Oral Anticoagulation Therapy Assessed during an Intermediate Medication Review in Swiss Community Pharmacies. PHARMACY 2020; 8:pharmacy8020054. [PMID: 32231095 PMCID: PMC7355591 DOI: 10.3390/pharmacy8020054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Therapy with oral anticoagulation (OAC) can be challenging, especially in high risk groups such as chronic patients. Gaps in patient knowledge about OAC are linked to reduced effectiveness and safety of treatment. The objectives of this study were i) to assess OAC knowledge gathered during an intermediate medication review (MR) in patients taking vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC); ii) to assess OAC knowledge two weeks after the MR, and iii) to evaluate patient satisfaction with the MR service in community pharmacies. Methods: Chronic OAC patients were invited for a regular MR service in Swiss community pharmacies, the so-called “Polymedication-Check” (PMC). OAC knowledge was assessed with seven newly generated items asked face-to-face during a PMC and by telephone two weeks later. Knowledge gaps, pharmacists’ spontaneous interventions, and patient satisfaction were documented by observing pharmacy students. Treatment groups were compared. Results: Of all patients (n = 81), the number of patients with one or more knowledge gaps decreased from 66% to 31.3% after PMC (p < 0.001). NOAC patients (n = 31) had more knowledge gaps than VKA patients (n = 50; p < 0.05). Most patients (98.6%) were satisfied with the counselling provided by the pharmacists. Conclusion: The majority of chronic OAC patients shows knowledge gaps. Although spontaneous, the provision of tailored education during a PMC increased patient OAC knowledge.
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Yiu AWP, Lee VW, Ng KK, Bajorek BV. Patient Feedback on a Warfarin Action Plan Used in a Local Australian Physician Practice Setting. Ther Innov Regul Sci 2019:2168479019865900. [PMID: 31426683 DOI: 10.1177/2168479019865900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Warfarin is a high-risk medicine, and older persons (those aged 65 years and older)1,2 who take this therapy need medicines information about it that is at a level which is both understandable and comprehensive to improve their knowledge about the risks and benefits of warfarin therapy.3,4 Therefore, the primary objective of this study was to report patient feedback on a Warfarin Action Plan (WAP) (leaflet) and identify patients' preferences regarding its content and format. The secondary objective was to canvass in-depth feedback regarding the participants' information needs and current information-seeking practices with respect to warfarin therapy. METHOD In an Australian General Practice medical centre setting, a qualitative study comprising 34 individual interviews was conducted. Emergent themes were elicited via a qualitative analysis using manual inductive coding. RESULTS The majority of participants gave very positive feedback on the WAP leaflet, stating that it was a useful and concise resource. In canvasing this feedback, 4 themes emerged: (1) the need for information about warfarin therapy, (2) reliance on doctors and/or pharmacists for information, (3) the need for information to normalize their daily life, and (4) patients and carers acting on the new information. CONCLUSION The WAP is a simple and well-received tool that meets the knowledge and education needs about warfarin therapy for older people and their carers.
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Affiliation(s)
- Angela W P Yiu
- 1 University Technology of Sydney, Sydney, New South Wales, Australia
- 2 Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Vincent W Lee
- 3 Department of Renal Medicine, University of Sydney, Sydney, New South Wales, Australia
- 4 Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kingsley K Ng
- 2 Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Beata V Bajorek
- 1 University Technology of Sydney, Sydney, New South Wales, Australia
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Heinrich K, Sanchez K, Hui C, Talabi K, Perry M, Qin H, Nguyen H, Tatachar A. Impact of an electronic medium delivery of warfarin education in a low income, minority outpatient population: a pilot intervention study. BMC Public Health 2019; 19:1050. [PMID: 31382942 PMCID: PMC6683532 DOI: 10.1186/s12889-019-7370-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/25/2019] [Indexed: 12/03/2022] Open
Abstract
Background Warfarin is classified as a high-alert medication for ambulatory healthcare and safe guards for high-alert medications are necessary, including the practice of mandatory patient education. The high cost of hospitalizations related to adverse events combined with the average bleeding event rate of 7–8% in spite of routine patient education, suggests the importance of new approaches to standardized health education on warfarin. We sought to evaluate the impact of a warfarin educational video using an electronic tablet on patient knowledge and to determine patients’ satisfaction with the use of an electronic tablet for educational purposes in outpatient clinics serving a low income, minority population. Methods A warfarin educational video delivered on an electronic tablet (iPad) was delivered at two pharmacist-managed anticoagulation clinics to uninsured patients whose annual income is equal or less than two hundred percent below the poverty level were offered. Patients (n = 18) completed a pre-video and post-video knowledge test on warfarin before and after viewing the warfarin educational video on an electronic tablet and a follow-up test to measure the retention of knowledge and a patient satisfaction survey at 60 days. The primary outcome was change in knowledge test scores. Other outcome measures included adherence rates, adverse events, time in therapeutic INR range, and patient-reported satisfaction scores. Results The majority of patients were uninsured men taking warfarin for atrial fibrillation (n = 5). The median scores at post-video knowledge test and follow-up knowledge test were significantly higher than that for the pre-knowledge test (12 (11–12) vs. 10(8–11), p < 0.001). The study group had a ‘time in therapeutic INR’ range of 56.3%, a rate of adverse events of 24.5%, and a self-reported adherence rate to warfarin of 94.1%. The majority of patients also had positive responses to the patient satisfaction survey. Conclusions Patient education delivered via iPad to facilitate knowledge of medication can serve as a useful tool for educating patients about warfarin and warfarin therapy. Use of an electronic medium may be a unique way to provide standard medication education to patients. Trial registration The study was retrospectively registered with: NCT03650777; 9/18/18.
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Affiliation(s)
- Krista Heinrich
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA.
| | - Katherine Sanchez
- Center for Applied Health Research, Baylor Scott and White Research Institute, 8080 North Central Expressway, Suite 1050, Dallas, TX, 75206, USA
| | - Cecilia Hui
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA
| | - Kiara Talabi
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA
| | - Marlena Perry
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA
| | - Huanying Qin
- Department of Quantitative Sciences, Baylor Scott and White Health, 8080 N. Central Expressway, Suite 900, Dallas, TX, 75206, USA
| | - Hoa Nguyen
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA.,Department of Quantitative Sciences, Baylor Scott and White Health, 8080 N. Central Expressway, Suite 900, Dallas, TX, 75206, USA
| | - Amulya Tatachar
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA.,University of North Texas System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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Yiu A, Bajorek B. Patient-focused interventions to support vulnerable people using oral anticoagulants: a narrative review. Ther Adv Drug Saf 2019; 10:2042098619847423. [PMID: 31205676 PMCID: PMC6535713 DOI: 10.1177/2042098619847423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 04/01/2019] [Indexed: 12/18/2022] Open
Abstract
The aim of this review was to identify patient-focused interventions that have been trialed to support vulnerable patient populations taking oral anticoagulants (warfarin and the direct-acting oral anticoagulants (DOACs)) such as older persons (65 years and over), those with limited health literacy, and those from culturally and linguistically diverse (CALD) backgrounds. This review also aimed to report on the effects of these interventions on outcomes relevant to the use of anticoagulant therapy. Original articles published between 1 January 1995 and 30 June 2017 were identified using several electronic databases such as Medline, Ovid, Embase, Scopus, Cochrane, and Google Scholar. The following terms were used for the three-tiered search: Tier 1, elderly, aged, older adult, geriatrics; Tier 2, health literacy, literacy, low health literacy, low English proficiency, patient literacy; and Tier 3, ethnicity, ethnic, ethnic groups, CALD, culturally and linguistically diverse, NESB, non-English speaking background, race, racial groups, religion, religious groups, and minority groups. The terms for each tier were combined with the following terms: anticoagulants, anticoagulation, warfarin, apixaban, dabigatran, rivaroxaban, DOACS, new oral anticoagulants, novel oral anticoagulants, patient care, patient knowledge, comprehension, patient education, patient participation, and communication. A total of 41 studies were identified. Most of the interventions identified included older persons taking warfarin who were monitored using the international normalized ratio (INR) and who received patient education. Many interventions reported a significant positive impact on patients' knowledge, reduction in the number of adverse events caused by hemorrhage, and better INR control. More research on patient-focused interventions is needed that includes patients with limited health literacy, those from CALD backgrounds, and family members and caregivers of patients taking oral anticoagulants.
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Affiliation(s)
- Angela Yiu
- Graduate School of Health – Pharmacy, University Technology of Sydney, Level 4, Building 7, 67 Thomas Street, Ultimo, NSW 2007, Australia
| | - Beata Bajorek
- Graduate School of Health – Pharmacy, University of Technology Sydney and Pharmacy Department, Royal North Shore Hospital, Australia
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Patino MI, Kraus P, Bishop MA. Implementation of patient education software in an anticoagulation clinic to decrease visit times for new patient appointments. PATIENT EDUCATION AND COUNSELING 2019; 102:961-967. [PMID: 30665730 DOI: 10.1016/j.pec.2018.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Patient education on high-risk medications such as warfarin is important, and they require quick follow-up after initiation to maximize efficacy and safety. In our Anticoagulation Clinic, two 60-minute new patient appointments are available each day, contributing to prolonged lead-time. We instituted standardized warfarin video education to shorten in-clinic-room visit time, to potentially increase new patient appointments. METHODS Patients viewed the video in the waiting area with a goal to decrease visit times by 15 min (25%), before pharmacists completed their visit. Data collected included time spent in the clinic room, education comprehension, and patient feedback. RESULTS Ninety patient visits were evaluated in one pre-intervention and two post-intervention phases. Patients who received video education spent less time in the clinic room versus those who had not (52.4 vs 39.4 min, p = 0.001), and two-thirds of all post-intervention visits achieved 25% reduction in visit time. There were no significant differences in education comprehension and patient satisfaction. CONCLUSION Video education significantly decreased in-clinic-room visit time, and most patients achieved a goal of 25% reduction in time spent, without a change in comprehension or patient satisfaction. PRACTICE IMPLICATIONS Implementation of video education can reduce clinic times in many patients without significantly impacting patient satisfaction.
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da Costa JM, Marcolino MS, Torres HC, de Resende RE, de Souza RP, Barbosa HC, Ribeiro DD, Martins MAP. Protocol of a clinical trial study involving educational intervention in patients treated with warfarin. Medicine (Baltimore) 2019; 98:e15829. [PMID: 31145324 PMCID: PMC6709162 DOI: 10.1097/md.0000000000015829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. Oral anticoagulation is an effective strategy for primary and secondary prevention of stroke in patients with AF. Warfarin is an oral anticoagulant widely prescribed and, despite its benefits, the achievement of the goals of drug therapy depends on patient involvement, among other factors. Educational interventions can contribute for effectiveness and safety of oral anticoagulation therapy. We sought to describe the protocol of a clinical trial designed to evaluate the effect of a patient-centered educational strategy focused on low-income patients with AF and poor anticoagulation control. METHODS Patients ≥18 years with AF, on warfarin for at least 6 months and time in therapeutic range (TTR) <60% will be recruited at 2 anticoagulation clinics (ACs) in Brazil. Patients from 1 AC will be allocated to the intervention group and patients from the other AC will be allocated to the control group. Intervention group will attend educational sessions based on a patient-centered care approach, and the control group will receive usual care. The intervention will be based on Paulo Freire's theory and tailored according to practices involving health empowerment and techniques applied to individuals with limited socioeconomic status. The intervention is estimated to last 5 months. We will consider TTR as the primary outcome and knowledge and self-reported non-adherence to warfarin therapy as secondary outcomes. TTR values and non-adherence will be measured before intervention (T0) and at times immediately after (T1), and 3 (T2), 6 (T3), 9 (T4), and 12 (T5) months after intervention. Knowledge will be measured at times T0, T1 e T5. The calculated sample size indicated 85 patients in each group. DISCUSSION The proposed study aims to investigate whether an innovative educational approach to deliver care to a low-income population on warfarin improves anticoagulation control. Once our hypothesis is confirmed, our findings are expected to help improving anticoagulation control, knowledge on warfarin therapy and adherence to drug therapy. Thus, we believe our results may contribute to improve oral anticoagulation effectiveness in a low-income population. TRIAL REGISTRATION Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR- 9cy6py and UTN: U1111-1217-0151 (March, 2019).
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Affiliation(s)
| | | | | | | | - Renan Pedra de Souza
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Mifsud EM, Wirth F, Camilleri L, Azzopardi LM, Serracino-Inglott A. Pharmacist-led medicine use review in community pharmacy for patients on warfarin. Int J Clin Pharm 2019; 41:741-750. [PMID: 31006832 DOI: 10.1007/s11096-019-00824-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/10/2019] [Indexed: 01/03/2023]
Abstract
Background Medicine use review by pharmacists has the potential to improve anticoagulation therapy management in patients on warfarin. Objective To develop, implement and evaluate a pharmacist-led medication use review service for patients on warfarin. Setting Six community pharmacies in Malta. Method Patients (N = 100) aged 18 or older and on warfarin were recruited through pre-selected community-pharmacies. These patients were then invited to attend two sessions: a review session (t1) and a follow-up session after 2 months (t2). During the medication use review session, medication reconciliation was performed (a) to detect drug-related problems using the DOCUMENT classification system, (b) to develop an individualised care plan for each patient and (c) to recommend an action for each identified problem for physician, pharmacist or patient consideration. At t2, the degree of acceptance of the recommendations was determined by assessing the number of drug-related problems for which action was taken to address the problem. International normalisation ration (INR) control was evaluated by calculating the percentage Time in Therapeutic Range (TTR) at t1 and t2 using the Rosendaal linear interpolation method. Main outcome measures Frequency and type of drug-related problems detected; percentage of accepted recommendations; and INR control. Results A total of 481 drug-related problems were identified; 40% (n = 190) were related to warfarin treatment. Need for monitoring (30%; n = 145), lack of compliance (20%; n = 97) and need for patient education (19%; n = 90) were the top three problems identified. There was a significant correlation between frequency of the problems and number of chronic medications (Spearman Correlation 0.583, p < 0.001), number of comorbidities (Spearman Correlation 0.327, p = 0.001) and older age (Spearman Correlation 0.285, p = 0.04). A total of 475 recommendations were followed-up; 49% (n = 234) were referred for consideration by the physician. The percentage of recommendations accepted (84%; n = 397) was significantly higher than the percentage of recommendations not accepted (16%; n = 78) (p < 0.001). The time in therapeutic range improved significantly from 68.7% at t1 to 79.8% at t2 (p = 0.01). Conclusions The high percentage of accepted recommendations and the improvement in INR control indicate that a pharmacist-led medication use review service in community pharmacy contributes to improving anticoagulation therapy management in patients on warfarin.
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Affiliation(s)
- Elena M Mifsud
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
| | - Francesca Wirth
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Liberato Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - Lilian M Azzopardi
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Abstract
OBJECTIVES To identify and examine individual characteristics and socioeconomic factors that contribute to the knowledge of patients who receive warfarin anticoagulation. METHODS All patients treated using warfarin for anticoagulation were enrolled during a 6-month period at a university-affiliated cardiac clinic. All relevant demographic and clinical information were collected and the Anticoagulation Knowledge Assessment (AKA) questionnaire consisting of 29 questions was administered. After completion, the questionnaires were scored and the percent correct answers were analyzed for overall scores, as well as the following categories: drug/food interactions, pharmacological knowledge, recognition of complications, and patient compliance. Multiple linear regression analysis was used to identify the contributing factors to the knowledge level of the patients in each category. RESULTS One hundred fifty patients (79 men and 71 women) with a median age of 61.5 years completed the AKA questionnaire. The average overall score was 29.3%. Living alone (P = 0.008), higher levels of education (P = 0.001), and durations of ≥3 years of warfarin therapy (P = 0.018) positively impacted overall AKA scores. CONCLUSIONS Socioeconomic factors and level of general education remain the most important elements determining the patient awareness of therapeutic goals, possible drug/food interaction, recognition of adverse effects, and compliance of warfarin treatment.
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Baysal E, Midilli TS. Effects of structured patient education on knowledge level and INR control of patients receiving warfarin: Randomized Controlled Trial. Pak J Med Sci 2018; 34:240-246. [PMID: 29805387 PMCID: PMC5954358 DOI: 10.12669/pjms.342.14216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine the effects of patient education about the safety of warfarin therapy on related-knowledge levels and on International Normalized Ratio (INR) control. Methods: In the study, randomized controlled experimental study design was used. It was conducted between September 2014–March 2015 with 63 patients who use warfarin at least two months at cardiology and cardiovascular surgery outpatient departments of two different hospitals in Manisa. Participants in the intervention group received one-to-one education about the safety of warfarin therapy and a booklet. Participants in the control group received usual care. Patients’ warfarin knowledge levels in both groups were measured three times at monthly intervals. Results: Before education warfarin knowledge levels were inadequate in intervention group, but it was higher after education and reached a good level. No significant difference was found between the International Normalized Ratio controls of the two groups. No significant relationship was found between pre- and post-education warfarin knowledge levels and the INR number in the therapeutic range. Conclusion: One-to-one education supported by written and visual material was effective in increasing patients’ warfarin knowledge levels.
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Affiliation(s)
- Ebru Baysal
- Ebru Baysal, Research Assistant, Department of Fundamentals Nursing, Ege University School of Nursing, Izmir, Turkey
| | - Tulay Sagkal Midilli
- Tulay Sagkal Midilli, Assistant Professor, Department of Fundamentals Nursing, Manisa Celal Bayar University School of Health, Manisa, Turkey
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Treatment Satisfaction Questionnaire for Medication: Validation of the Translated Arabic Version among Patients Undergoing Warfarin Therapy in Saudi Arabia. Value Health Reg Issues 2018; 16:14-21. [PMID: 29626737 DOI: 10.1016/j.vhri.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/10/2017] [Accepted: 01/05/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To validate the psychometric properties of the translated Arabic version of the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) for patients on warfarin therapy in Saudi anticoagulation clinics (ACCs). METHODS A cross-sectional survey was conducted at the Security Forces Hospital ACC in Riyadh, Saudi Arabia. It involved administering questionnaires related to patients' satisfaction and assessing adherence through interviews. The quality of the international normalized ratio control was assessed using the Rosendaal method. A psychometric evaluation of TSQM 1.4 was carried out, addressing internal consistency and known-groups and convergent validity. RESULTS A total of 101 patients completed the questionnaire with an 80% response rate. The independent Cronbach α values for the effectiveness, side effects, and global satisfaction domains were consistently higher than 0.75, demonstrating good internal consistency and suitability of these domains for application in the current patients' setting. When these domains were used together in a multivariable logistic regression model of adherence, the only domain that remained significant was TSQM effectiveness (P = 0.017). Interestingly, a higher likelihood of moderate to optimal international normalized ratio control was significantly and independently associated with increased satisfaction scores in the effectiveness and convenience domains, but not in the side effects and global satisfaction domains. CONCLUSIONS This study provides evidence in favor of the reliability and validity of the Arabic version of TSQM 1.4 as a useful measure of satisfaction with anticoagulant therapy in patients visiting ACCs. The TSQM subscales in this patient setting seem to detect a clinically meaningful change over time, enhancing the potential of their use in routine practice.
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Yiu AW, Bajorek BV. Health literacy and knowledge in a cohort of Australian patients taking warfarin. Pharm Pract (Granada) 2018; 16:1080. [PMID: 29619136 PMCID: PMC5881480 DOI: 10.18549/pharmpract.2018.01.1080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/17/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To 1) characterise older patients taking warfarin, 2) assess these patients' level of warfarin knowledge, and 3) describe their strengths and limitations in health literacy, and 4) explore relationships between participants' characteristics, warfarin knowledge and health literacy. METHODS A warfarin knowledge questionnaire and Health Literacy Questionnaire (HLQ) were administered to older patients (aged >65 years, N=34) taking warfarin in an Australian general practice setting. RESULTS Key gaps in participant knowledge pertained to the consequences of an international normalized ratio (INR) being below the target INR range and safety issues such as when to seek medical attention. A limitation for participants with a lower level of health literacy was the ability to appraise health information. Patients who needed assistance in completing the HLQs had significantly lower warfarin knowledge scores (p=0.03). Overseas-born participants and those taking 5 or more long-term medications had lower HLQ scores for specific scales (p<0.05). CONCLUSION In this study warfarin knowledge gaps and a limitation of health literacy amongst a small sample of older patients were identified. The findings suggest that education and resources may need to be tailored to the needs of older patients taking warfarin and their carers to address these knowledge gaps and limitations in health literacy. Patients who may need greater support include those that need assistance in completing the HLQ, are overseas-born, or are taking 5 or more long-term medications.
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Affiliation(s)
- Angela W Yiu
- B Medical Science. Pharmacist. Graduate School of Health, University of Technology of Sydney. Ultimo, NSW (Australia).
| | - Beata V Bajorek
- Associate Professor. Graduate School of Health, University of Technology of Sydney. Ultimo, NSW (Australia).
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Shilbayeh SAR, Almutairi WA, Alyahya SA, Alshammari NH, Shaheen E, Adam A. Validation of knowledge and adherence assessment tools among patients on warfarin therapy in a Saudi hospital anticoagulant clinic. Int J Clin Pharm 2017; 40:56-66. [PMID: 29189976 DOI: 10.1007/s11096-017-0569-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/23/2017] [Indexed: 12/13/2022]
Abstract
Background Although it can result in serious complications due to its narrow therapeutic index, warfarin is widely used in the treatment and prevention of thromboembolic disorders. However, patients' adherence and knowledge are determinants of therapeutic success. Objective We sought to validate instruments to provide a reliable means of identifying gaps in patient understanding and nonadherence to inform targeted pharmacists' interventions to improve these measures. Methods A cross-sectional survey was conducted. Patients' knowledge about warfarin was rated using an Arabic-language tool. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). The international normalized ratio (INR) control was quantified by the Rosendaal Method. Setting At the Security Forces hospital anticoagulant clinic (ACC), Riyadh. Main outcome measure Validity of a Knowledge and adherence tool. Results Totally, 101 patients completed the questionnaires. Interestingly, the knowledge tool demonstrated good internal consistency (total Cronbach's alpha = 0.75) and significant concurrent validity with adherence levels. Fifty-two patients were classified as having unsatisfactory knowledge. Deficiency in knowledge was most obvious with respect to the consequences of missing a dose and when to seek immediate medical attention. The MMAS-8 had moderate reliability (Cronbach's alpha = 0.65); however, its concurrent validity with good INR control was not demonstrated. Conclusions This study revealed high prevalence of nonadherence and poor knowledge in the population visiting the ACC. Given that available knowledge and adherence tools seemed to have little validity in predicting clinical outcomes, structured tools should be designed, considering progression in clinical outcomes with future pharmacists' interventions.
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Affiliation(s)
- Sireen Abdul Rahim Shilbayeh
- Department of Pharmacy Practice,, Pharmacy College Princess Nourah bint Abdul Rahman University, Riyadh, 11671, P.O. Box 84428, Saudi Arabia.
| | - Wejdan Ali Almutairi
- Department of Pharmacy Practice,, Pharmacy College Princess Nourah bint Abdul Rahman University, Riyadh, 11671, P.O. Box 84428, Saudi Arabia
| | - Sarah Ahmed Alyahya
- Department of Pharmacy Practice,, Pharmacy College Princess Nourah bint Abdul Rahman University, Riyadh, 11671, P.O. Box 84428, Saudi Arabia
| | - Nouf Hayef Alshammari
- Department of Pharmacy Practice,, Pharmacy College Princess Nourah bint Abdul Rahman University, Riyadh, 11671, P.O. Box 84428, Saudi Arabia
| | - Eiad Shaheen
- Department of Pharmacy Practice,, Pharmacy College Princess Nourah bint Abdul Rahman University, Riyadh, 11671, P.O. Box 84428, Saudi Arabia
| | - Alya Adam
- Department of Pharmacy Practice,, Pharmacy College Princess Nourah bint Abdul Rahman University, Riyadh, 11671, P.O. Box 84428, Saudi Arabia
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Maikranz V, Siebenhofer A, Ulrich LR, Mergenthal K, Schulz-Rothe S, Kemperdick B, Rauck S, Pregartner G, Berghold A, Gerlach FM, Petersen JJ. Does a complex intervention increase patient knowledge about oral anticoagulation? - a cluster-randomised controlled trial. BMC FAMILY PRACTICE 2017; 18:15. [PMID: 28166725 PMCID: PMC5295216 DOI: 10.1186/s12875-017-0588-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/19/2017] [Indexed: 12/13/2022]
Abstract
Background Oral anticoagulation therapy (OAT) is a challenge in general practice, especially for high-risk groups such as the elderly. Insufficient patient knowledge about safety-relevant aspects of OAT is considered to be one of the main reasons for complications. The research question addressed in this manuscript is whether a complex intervention that includes practice-based case management, self-management of OAT and additional patient and practice team education improves patient knowledge about anticoagulation therapy compared to a control group of patients receiving usual care (as a secondary objective of the Primary Care Management for Optimised Antithrombotic Treatment (PICANT) trial). Methods The cluster-randomised controlled PICANT trial was conducted in 52 general practices in Germany, between 2012 and 2015. Trial participants were patients with a long-term indication for oral anticoagulation. A questionnaire was used to assess knowledge at baseline, after 12, and after 24 months. The questionnaire consists of 13 items (with a range of 0 to 13 sum-score points) covering topics related to intervention. Differences in the development of patient knowledge between intervention and control groups compared to baseline were assessed for each follow-up by means of linear mixed-effects models. Results Seven hundred thirty-six patients were included at baseline, of whom 95.4% continued to participate after 12 months, and 89.3% after 24 months. The average age of patients was 73.5 years (SD 9.4), and they mainly suffered from atrial fibrillation (81.1%). Patients in the intervention and control groups had similar knowledge about oral anticoagulation at baseline (5.6 (SD 2.3) in both groups). After 12 months, the improvement in the level of knowledge (compared to baseline) was significantly larger in the intervention group than in the control group (0.78 (SD 2.5) vs. 0.04 (SD 2.3); p = 0.0009). After 24 months, the difference between both groups was still statistically significant (0.6 (SD 2.6) vs. -0.3 (SD 2.3); p = 0.0001). Conclusion Since this intervention was effective, it should be established in general practice as a means of improving patient knowledge about oral anticoagulation. Trial registration Current controlled trials ISRCTN41847489; Date of registration: 13/04/2012
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Affiliation(s)
- Verena Maikranz
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Andrea Siebenhofer
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt, Germany. .,Institute of General Practice and Evidence-based Health Services Research, Medical University Graz, Auenbruggerplatz 2/9, A-8036, Graz, Austria.
| | - Lisa-R Ulrich
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Sylvia Schulz-Rothe
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Birgit Kemperdick
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Sandra Rauck
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Juliana J Petersen
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt, Germany
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Nybo MS, Skov J. Patient knowledge of anticoagulant treatment does not correlate with treatment quality. Public Health 2016; 141:17-22. [PMID: 27931994 DOI: 10.1016/j.puhe.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objectives of this study were to investigate whether patient knowledge is a predictor of treatment stability in anticoagulant clinic patients and to evaluate the correlation between the patients' subjective assessment of own knowledge and their score on a validated knowledge assessment instrument. STUDY DESIGN This is a prospective study where international normalized ratio (INR) stability was followed up 6 months after knowledge assessment. METHODS We analyzed data of 42 consecutive patients new to vitamin-K antagonist (VKA) treatment and 64 experienced patients from an anticoagulant clinic offering patient education. The patients filled out a VKA knowledge assessment questionnaire with 24 items under standardized conditions, and simultaneously, they were asked about their subjective knowledge. Subsequently, time in range of INR (TIR) was collected for each patient. RESULTS Out of the 106 patients, 52 had 18 or more correct answers (>75%), defined as a 'satisfactory level' of objective knowledge. The average TIR was 73%, and treatment stability was significantly higher in experienced patients than new patients. We found no correlation between objective knowledge and TIR (Spearman rho = -0.03, P = 0.78). Most patients (77%) reported a high subjective knowledge of VKA, but no correlation was found between objective and subjective knowledge (Spearman rho = 0.129, P = 0.19). CONCLUSION We observed that many patients had a low level of knowledge of VKA, despite high treatment stability and patient education. The patient's own assessment of knowledge was not found to predict objective knowledge, which could have implications for selection of patients for self-test or self-management of treatment.
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Affiliation(s)
- M S Nybo
- Unit for Thrombosis Research, Department of Public Health, University of Southern Denmark, Denmark
| | - J Skov
- Unit for Thrombosis Research, Department of Public Health, University of Southern Denmark, Denmark.
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Marcatto LR, Sacilotto L, Bueno CT, Facin M, Strunz CMC, Darrieux FCC, Scanavacca MI, Krieger JE, Pereira AC, Santos PCJL. Evaluation of a pharmacogenetic-based warfarin dosing algorithm in patients with low time in therapeutic range - study protocol for a randomized controlled trial. BMC Cardiovasc Disord 2016; 16:224. [PMID: 27855643 PMCID: PMC5112885 DOI: 10.1186/s12872-016-0405-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/08/2016] [Indexed: 12/30/2022] Open
Abstract
Background Time in therapeutic range (TTR) is a measurement of quality of warfarin therapy and lower TTR values (<50%) are associated with greater risk of thromboembolic and bleeding events. Recently, we developed a pharmacogenetic-based warfarin dosing algorithm specifically calibrated for a Brazilian patient sample. The aims of this study are: to evaluate the impact of a genetic-based algorithm, compared to traditional anticoagulation, in the time to achieve the therapeutic target and in TTR percentage; and to assess the cost-effectiveness of genotype-guided warfarin dosing in a specific cohort of patients with low TTR (<50%) from a tertiary cardiovascular hospital. Methods/design This study is a randomized controlled trial in patients (n = 300) with atrial fibrillation with TTR < 50%, based on the last three INR values. At the first consultation, patients will be randomized into two groups: TA group (traditional anticoagulation) and PA group (pharmacogenetic anticoagulation). For the first group, the physician will adjust the dose according to current INR value and, for the second group, a pharmacogenetic algorithm will be used. At the second, third, fourth and fifth consultations (with an interval of 7 days each) INR will be measured and, if necessary, the dose will be adjusted based on guidelines. Afterwards, patients who are INR stable will begin measuring their INR in 30 day intervals; if the patient’s INR is not stable, the patient will return in 7 days for a new measurement of the INR. Outcomes measures will include the time to achieve the therapeutic target and the percentage of TTR at 4 and 12 weeks. In addition, as a secondary end-point, pharmacoeconomic analysis will be carried out. Ethical approval was granted by the Ethics Committee for Medical Research on Human Beings of the Clinical Hospital of the University of São Paulo Medical School. Discussion This randomized study will include patients with low TTR and it will evaluate whether a population-specific genetic algorithm might be more effective than traditional anticoagulation for a selected group of poorly anticoagulated patients. Trial registration ClinicalTrials.gov, NCT02592980. Registered on 29 October 2015.
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Affiliation(s)
- Leiliane Rodrigues Marcatto
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, SP, CEP 05403-000, Brazil
| | - Luciana Sacilotto
- Arrhythmia Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, SP, CEP 05403-000, Brazil
| | - Carolina Tosin Bueno
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, SP, CEP 05403-000, Brazil
| | - Mirella Facin
- Arrhythmia Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, SP, CEP 05403-000, Brazil
| | - Celia Maria Cassaro Strunz
- Clinical Laboratory, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, SP, CEP 05403-000, Brazil
| | - Francisco Carlos Costa Darrieux
- Arrhythmia Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, SP, CEP 05403-000, Brazil
| | - Maurício Ibrahim Scanavacca
- Arrhythmia Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, SP, CEP 05403-000, Brazil
| | - Jose Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, SP, CEP 05403-000, Brazil
| | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, SP, CEP 05403-000, Brazil.
| | - Paulo Caleb Junior Lima Santos
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, SP, CEP 05403-000, Brazil.
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Quality use of medicines in neonatal care: a review of measures of quality used to evaluate the appropriateness and rational use of medication within the NICU. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Krzyżaniak N, Pawłowska I, Bajorek B. Review of drug utilization patterns in NICUs worldwide. J Clin Pharm Ther 2016; 41:612-620. [PMID: 27578606 DOI: 10.1111/jcpt.12440] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/29/2016] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES When considering acute care settings, such as the neonatal intensive care unit (NICU), the inappropriate use of medicines poses a great risk to vulnerable babies at the start of their lives. However, there is limited published literature that explores the current medication management practices in NICUs and where the main misuse issues lie. Therefore, the purpose of this review was to give an overview of medicine use in NICUs worldwide and identify therapeutic areas requiring more targeted pharmaceutical care. Specific objectives include the following: identifying the most commonly used medicines, comparing these to the A-PINCH (Anti-infectives, Potassium and other electrolytes, Insulin, Narcotics and sedatives, Chemotherapy agents, Heparin and other anticoagulants), high-risk medicines list, and determining whether there are any differences in medicine use between countries. METHOD Quasi-systematic literature review. SEARCH STRATEGY Google Scholar, MEDLINE/PubMed, Scopus and EMBASE were searched utilizing selected MeSH terms. RESULTS A total of 19 articles from 12 countries were reviewed. Medication use between countries was very similar with no discernible differences in types of medicines prescribed. The most commonly used medicines included gentamicin, ampicillin, caffeine, furosemide and vitamin K. The median number of medicines prescribed per patient ranged from 3 to 11, and an inverse relationship was identified between gestational age and the number of medications that were prescribed. Nine of the 20 most commonly used medicines were listed as A-PINCH medicines, and included antibiotics, fentanyl, morphine and heparin. Inappropriate prescribing, as well as the high use of off-label/unlicensed medicines, was highlighted as areas of practice that require consideration to improve medication safety and minimize the potential risk for medication errors. WHAT IS NEW AND CONCLUSION Overall, the types of medicines used in NICUs worldwide are similar, with consistent reports on the common use of antibiotics, caffeine and vitamins. However, it cannot be definitively stated that the findings of the review accurately depict current practice in NICUs, due to the limited amount of published literature available. There are several areas of concern that warrant further investigation to improve rational use of medicines in the neonatal populations, including high use of antibiotics and off-label and unlicensed medicines.
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Affiliation(s)
- N Krzyżaniak
- Graduate School of Health (Pharmacy), University of Technology Sydney, Broadway, NSW, Australia.
| | - I Pawłowska
- Pharmacology Department, Medical University of Gdansk, Gdańsk, Poland
| | - B Bajorek
- Graduate School of Health (Pharmacy), University of Technology Sydney, Broadway, NSW, Australia
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Krzyzaniak N, Bajorek B. A global perspective of the roles of the pharmacist in the NICU. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:107-120. [DOI: 10.1111/ijpp.12284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 05/23/2016] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives
To describe pharmacist practice and roles performed in the neonatal intensive care unit (NICU) worldwide and to map these findings along the medicines management pathway (MMP).
Method
Quasi-systematic review.
Search Strategy
Google Scholar, Medline/PubMed and Embase were searched utilising the selected MeSH terms.
Results
Thirty sources of information were reviewed. Overall, pharmacist practice in the NICU involves a wide-range of roles, with the most commonly reported involving patient medication chart review, therapeutic drug monitoring and the provision of medication information. Studies highlight that pharmacist contribution to total parenteral nutrition (TPN) regimens and patient medication chart review is beneficial to patient outcomes. Roles beyond the regular scope of practice included involvement in immunisation programmes and research. Most of the data were collected from the USA (13 of 30), followed by the UK (6 of 30) and reports from other countries. The American, British, South African and Australian articles have reported very similar roles, with a pharmacist firmly integrated into the overall structure of the NICU team.
Conclusion
The literature identifies that there is insufficient evidence to describe what roles are currently performed in NICUs worldwide. This is due to the lack of recently published articles leading to a large gap in knowledge in understanding what contemporary pharmaceutical services in the NICU comprise. Further research is required to address these gaps in knowledge, and identify the impact of the pharmacist's role on neonatal patient outcomes as well as to determine how to better resource NICUs to access pharmacy services.
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Affiliation(s)
- Natalia Krzyzaniak
- University of Technology Sydney, Graduate School of Health (Pharmacy), Broadway, NSW, Australia
| | - Beata Bajorek
- University of Technology Sydney, Graduate School of Health (Pharmacy), Broadway, NSW, Australia
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Shrestha S, Sapkota B, Kumpakha A, Acharya U, Sharma R. Evaluation of patients' knowledge on warfarin in outpatient pharmacy of a tertiary care cardiac center. BMC Res Notes 2015; 8:429. [PMID: 26358332 PMCID: PMC4566289 DOI: 10.1186/s13104-015-1416-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 09/07/2015] [Indexed: 11/22/2022] Open
Abstract
Background Warfarin is widely used for the prevention and treatment of cardiac, thromboembolic and hypercoagulable diseases. Since warfarin is a narrow therapeutic index medicine, it requires close monitoring when used in the outpatient setting and on long term basis. Warfarin has been found to be associated with a number of complications especially bleeding. Patients’ knowledge on warfarin can improve anticoagulation control with decrease in adverse drug reaction and other associated complications. The objective was to assess knowledge level of warfarin therapy among its users and to provide adequate education and counseling to the patients. Methods In the present cross sectional study, 34 patients on warfarin were interviewed. Patients’ knowledge on warfarin was assessed using a validated Anticoagulation Knowledge Assessment (AKA) questionnaire comprising 29 questions. Each correct answer scored 3.45 points whereas an incorrect answer scored zero point. Patient who answered at least 21 questions correctly or scored (21 × 3.45 = 72.4 %) was considered to have adequate level of knowledge or have obtained a passing score. Association between independent variables and AKA score was assessed using Pearson Chi square test or Fisher’s exact test for categorical variables. Patients were counseled regarding proper warfarin use by the researcher pharmacists at the end of each data collection schedule. Results Of the 34 patients, only 5.8 % (n = 2) achieved a passing score whereas 94.1 % (n = 32) failed to achieve the passing score. 67.6 % of the patients (n = 23) achieved a score below 50 %. More than 50 % of the patients incorrectly answered 15 questions in the questionnaire. None of the patients scored 100 %. No significant association was found between age, gender of patients and total warfarin score. A significant association (p < 0.05) was found between duration of warfarin therapy and total warfarin score. Conclusions Warfarin knowledge was poor among the patients. Hence, regular counseling with timely assessment of their understanding was felt necessary.
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Affiliation(s)
- Sweta Shrestha
- Kathmandu University School of Science Department of Pharmacy, Kathmandu, Nepal.
| | - Binaya Sapkota
- Government of Nepal Civil Service Hospital, Minbhawan, Kathmandu, Nepal.
| | | | - Upasana Acharya
- Kathmandu University School of Science Department of Pharmacy, Kathmandu, Nepal.
| | - Rashmi Sharma
- Kathmandu University School of Science Department of Pharmacy, Kathmandu, Nepal.
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Cressman AM, Macdonald EM, Yao Z, Austin PC, Gomes T, Paterson JM, Kapral MK, Mamdani MM, Juurlink DN. Socioeconomic status and risk of hemorrhage during warfarin therapy for atrial fibrillation: A population-based study. Am Heart J 2015; 170:133-40, 140.e1-3. [PMID: 26093874 DOI: 10.1016/j.ahj.2015.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among patients taking warfarin, lower socioeconomic status is associated with poorer control of anticoagulation. However, the extent to which socioeconomic status influences the risk of hemorrhage is unknown. We examined the extent to which socioeconomic status influences the risk of hemorrhage in older individuals newly commencing warfarin therapy for atrial fibrillation. METHODS We conducted a population-based cohort study of individuals 66 years or older with atrial fibrillation who commenced warfarin therapy between April 1, 1997, and November 30th 2011, in Ontario, Canada. We used neighborhood-level income quintiles as a measure of socioeconomic status. The primary outcome was an emergency department visit or hospitalization for hemorrhage, and the secondary outcome was fatal hemorrhage. RESULTS We studied 166,742 older patients with atrial fibrillation who commenced warfarin therapy. Of these, 16,371 (9.8%) were hospitalized for hemorrhage during a median follow-up of 369 (interquartile range 102-865) days. After multivariable adjustment using Cox proportional hazards regression, we found that those in the lowest-income quintile faced an increased risk of hospitalization for hemorrhage relative to those in the highest quintile (adjusted hazard ratio 1.18, 95% CI 1.12-1.23). Similarly, the risk of fatal hemorrhage (n = 1,802) was increased in the lowest-income relative to the highest-income quintile (adjusted hazard ratio 1.28, 95% CI 1.11-1.48). CONCLUSIONS Among older individuals receiving warfarin therapy for atrial fibrillation, lower socioeconomic status is a risk factor for hemorrhage and hemorrhage-related mortality. This factor should be carefully considered when initiating and monitoring warfarin therapy.
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Nasser S, Cecchele R, Touma S, Han P, Nair K, Vizgoft J, Murdoch V, Mullan J, Bajorek B. Documentation of Warfarin Education provided to Hospital Patients: A Clinical Audit. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2012.tb00150.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Judy Mullan
- Graduate School of Medicine; University of Wollongong
| | - Beata Bajorek
- Graduate School of Health, Departments of Pharmacy and Clinical Pharmacology, Royal North Shore Hospital; University of Technology Sydney; St Leonards New South Wales
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Alphonsa A, Sharma KK, Sharma G, Bhatia R. Knowledge Regarding Oral Anticoagulation Therapy among Patients with Stroke and Those at High Risk of Thromboembolic Events. J Stroke Cerebrovasc Dis 2015; 24:668-72. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022] Open
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MacFarlane BV, Bergin JK, Reeves P, Matthews A. Australian pharmacies prevent potential adverse reactions in patients taking warfarin requesting over-the-counter analgesia. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:167-72. [DOI: 10.1111/ijpp.12152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 09/09/2014] [Indexed: 11/26/2022]
Abstract
Abstract
Objective
The objective of this article was to assess if Australian pharmacy staff prevent potential adverse reactions in warfarin patients requesting over-the-counter (OTC) analgesia.
Methods
Mystery shoppers entered 170 pharmacies across Australia to request OTC analgesia for a hypothetical patient with a wrist injury who currently takes warfarin following a heart valve replacement. The request was made to the first pharmacist or non-pharmacist staff member to approach the mystery shopper. The interaction was audio-taped and assessed by a pharmacist. The OTC analgesic recommended was assessed for the potential to cause an adverse bleeding event. The quality of advice given with the OTC analgesic was assessed against determined criteria. Results were compared with scenarios of similar request type where the hypothetical patient was not taking warfarin.
Key findings
Mystery shoppers enquiring about taking OTC analgesics concomitantly with warfarin had access to the pharmacist in 97.0% of cases. All 170 pharmacies recommended OTC analgesics that were less likely to cause adverse events when taken with warfarin. The advice given and the communication between pharmacy staff and mystery shoppers were of high quality.
Conclusion
Australian pharmacies support the quality use of medicines by patients taking warfarin by providing expeditious access to the pharmacist, appropriate recommendations of OTC analgesics, high standards of quality of advice and they communicate in a way to ensure ease of understanding by the consumer. The protocols used by pharmacy staff help prevent potentially serious adverse drug events.
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Affiliation(s)
| | - Jenny K Bergin
- The Australian College of Pharmacy, Canberra, ACT, Australia
| | - Peter Reeves
- The Australian College of Pharmacy, Canberra, ACT, Australia
| | - Andrew Matthews
- Pharmacy Transformation Group, The Pharmacy Guild of Australia, Canberra, ACT, Australia
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Schwartz L, Mazzola N, Hoffman RS, Howland MA, Mercurio-Zappala M, Nelson LS. Evaluating Patients' Understanding of Printed Warfarin Medication Information. J Pharm Pract 2014; 28:518-22. [PMID: 25147159 DOI: 10.1177/0897190014544816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Warfarin is a high-risk medication whose safe use may be greatly improved by patient education. This study evaluate evaluated patients' understanding of warfarin instructions, medication management, the Food and Drug Administration's (FDA) warfarin medication guide content, and patient information recommendations. METHODS Interviews conducted at 2 hospital-based outpatient primary care sites with patients initiated on warfarin therapy within the last year. RESULTS Interviews were conducted with 49 patients. Seventy percent were between 36 and 64 years old and reported taking between 1 and 18 different medications daily. Many (76%) received information about warfarin when first prescribed to them, 65% written and 60% verbal (answers reflect more than one response). Patients found content in the medication guide difficult to understand; 18% were unable to identify information about diet and 21% were unable to locate information about when to call their provider. Analysis showed that 19% had trouble with numeracy issues related to warfarin. Patients' suggestions of ways to convey warfarin information included more graphics, in-person counseling, and multilingual translations. CONCLUSION This study demonstrates gaps in patients' understanding of warfarin therapy. Relying solely on the information in the FDA medication guide is insufficient to guarantee adequate understanding. Utilizing the suggestions from patients' feedback on other ways to deliver information should help future patients with different learning abilities and styles.
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Affiliation(s)
- Lauren Schwartz
- Division of Medical Toxicology, NYU School of Medicine and Bellevue Hospital Center, New York, NY, USA NYC Poison Control Center, New York, NY, USA
| | - Nissa Mazzola
- St. John's University College of Pharmacy and Health Sciences Department of Clinical Pharmacy Practice, Queens, New York, NY, USA Division of General Internal Medicine, North Shore University Hospital, Great Neck, New York, NY, USA
| | - Robert S Hoffman
- Division of Medical Toxicology, NYU School of Medicine and Bellevue Hospital Center, New York, NY, USA NYC Poison Control Center, New York, NY, USA
| | - Mary Ann Howland
- Division of Medical Toxicology, NYU School of Medicine and Bellevue Hospital Center, New York, NY, USA NYC Poison Control Center, New York, NY, USA St. John's University College of Pharmacy and Health Sciences Department of Clinical Pharmacy Practice, Queens, New York, NY, USA
| | - Maria Mercurio-Zappala
- Division of Medical Toxicology, NYU School of Medicine and Bellevue Hospital Center, New York, NY, USA NYC Poison Control Center, New York, NY, USA
| | - Lewis S Nelson
- Division of Medical Toxicology, NYU School of Medicine and Bellevue Hospital Center, New York, NY, USA NYC Poison Control Center, New York, NY, USA
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Joshua JK, Kakkar N. Lacunae in patient knowledge about oral anticoagulant treatment: results of a questionnaire survey. Indian J Hematol Blood Transfus 2014; 31:275-80. [PMID: 25825572 DOI: 10.1007/s12288-014-0415-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/29/2014] [Indexed: 10/25/2022] Open
Abstract
Oral anticoagulation therapy is affected by the drug used, intensity of anticoagulation, physician's experience, patient compliance, laboratory testing and patient education. Patient education is a key factor in optimal anticoagulation and safety in patients on oral anticoagulant therapy. This study was done to assess the knowledge of patients regarding oral anticoagulant therapy in the outpatient setting. This prospective study was done over 2 months in 101 patients on outpatient oral anticoagulant therapy. A 20-point questionnaire on various aspects of oral anticoagulation therapy was administered to assess their knowledge. The answers were graded on a scale of 0-1. Scores were then added up to quantify the knowledge status in each patient. Descriptive statistics and Student's t test was used to analyse the data. The mean knowledge score among patients was 9.4/18 (52.2 %). More than half (52.8 %) of the patients had a score of <9. More than half (54.4 %) of the patients had adequate knowledge-(>80 % score-5.5/7) about the critical (must know) questions regarding OAT. Patients with age ≥60 years had lower mean scores compared to those <60 years of age (p = 0.028). Illiteracy was also associated (p < 0.0001) with poor scores. There are significant lacunae in the knowledge about oral anticoagulation among patients on outpatient treatment. Older age and illiteracy were associated with poor knowledge among patients. More emphasis needs to be given to the vital aspect of patient education to make this therapy safer for patients.
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Affiliation(s)
- Jisha K Joshua
- Department of Medicine, University of California, San Diego, CA USA
| | - Naveen Kakkar
- Department of Pathology, Christian Medical College and Hospital, Brown Road, Ludhiana, 141 008 Punjab India
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Oramasionwu CU, Bailey SC, Duffey KE, Shilliday BB, Brown LC, Denslow SA, Michalets EL. The association of health literacy with time in therapeutic range for patients on warfarin therapy. JOURNAL OF HEALTH COMMUNICATION 2014; 19 Suppl 2:19-28. [PMID: 25315581 DOI: 10.1080/10810730.2014.934934] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Patients on warfarin therapy need to achieve and maintain anticoagulation control in order to experience the benefits of treatment while minimizing bleeding risk. Low health literacy skills may hinder patients' ability to use and adhere to warfarin in a safe and effective manner. The authors conducted this study to evaluate the relationship between health literacy and anticoagulation control among patients on chronic warfarin therapy. Participants were recruited from 2 diverse anticoagulation clinics in North Carolina. Time in therapeutic range (TTR) for warfarin therapy was used as a measure of anticoagulation control. Health literacy was assessed using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Of the 198 study participants, 51% had limited health literacy (S-TOFHLA score of 0-90) and 33% had poor anticoagulation control (TTR<50%). Participants with limited health literacy were less likely to correctly answer warfarin-related knowledge questions. Limited health literacy was significantly associated with TTR<50% (adjusted odds ratio=2.34, 95% CI [1.01, 5.46]). Findings indicate that limited health literacy is associated with poor anticoagulation control for patients on warfarin therapy. Lack of medication understanding may hinder the safe and effective use of this narrow therapeutic index drug.
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Affiliation(s)
- Christine U Oramasionwu
- a Division of Pharmaceutical Outcomes and Policy , University of North Carolina , Chapel Hill , North Carolina , USA
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Nasser S, Mullan J, Bajorek B. Educating patients about warfarin therapy using information technology: A survey on healthcare professionals' perspectives. Pharm Pract (Granada) 2012; 10:97-104. [PMID: 24155824 PMCID: PMC3780484 DOI: 10.4321/s1886-36552012000200006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 05/07/2012] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To explore healthcare professionals' views about the benefits and challenges of using information technology (IT) resources for educating patients about their warfarin therapy. METHODS A cross-sectional survey of both community and hospital-based healthcare professionals (e.g., doctors, pharmacists and nurses) involved using a purpose-designed questionnaire. The questionnaires were distributed using a multi-modal approach to maximise response rates. RESULTS Of the total 300 questionnaires distributed, 109 completed surveys were received (43.3% response rate). Over half (53.2%) of the healthcare participants were aged between 40-59 years, the majority (59.5%) of whom were female. Fifty nine (54.1%) participants reported having had no access to warfarin-specific IT-based patient education resources, and a further 19 (38.0%) of the participants who had IT-access reported that they never used such resources. According to the healthcare participants, the main challenges associated with educating their patients about warfarin therapy included: patient-related factors, such as older age, language barriers, cognitive impairments and/or ethnic backgrounds or healthcare professional factors, such as time constraints. The healthcare professionals reported that there were several aspects about warfarin therapy which they found difficult to educate their patients about which is why they identified computers and interactive touch screen kiosks as preferred IT devices to deliver warfarin education resources in general practices, hospital-based clinics and community pharmacies. At the same time, the healthcare professionals also identified a number of facilitators (e.g., to reinforce warfarin education, to offer reliable and easily comprehensible information) and barriers (e.g., time and costs of using IT resources, difficulty in operating the resources) that could impact on the effective implementation of these devices in educating patients about their warfarin therapy. CONCLUSIONS The findings of the study suggest that there is a need for improving healthcare professionals' use of, and access to IT-based warfarin education resources for patients. The study findings also suggest addressing the concerns raised by the healthcare professionals when implementing such IT resources successfully to help educate patients about their warfarin therapy.
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Affiliation(s)
- Sayeed Nasser
- Faculty of Pharmacy, University of Sydney . Sydney, NSW ( Australia )
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