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Barbosa HC, Torres HDC, Oliveira JADQ, Santos RPDM, da Costa JM, Miranda LG, Pagano AS, Praxedes MFDS, Martins MAP. Construction and Validation of a Protocol Targeting Patients on Oral Anticoagulation with Warfarin. Arq Bras Cardiol 2023; 120:e20220576. [PMID: 37403872 PMCID: PMC10344350 DOI: 10.36660/abc.20220576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/03/2023] [Accepted: 04/05/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Warfarin is an oral anticoagulant that is very useful in preventing thromboembolism, though it is considered a drug with a high risk of causing adverse events. Considering the practical challenges in controlling oral anticoagulation, the patients on warfarin could benefit from educational strategies aimed at behavioral changes, active participation in self-care, and adherence to drug therapy. OBJECTIVE The aim was to construct and validate the EmpoderACO protocol for behavioral changes in warfarin patients. METHODS The methodological steps were: definition of concepts and domains of self-care, identification of objectives, construction and selection of items, assessment of content validity, and pre-test in the target population. RESULTS Relevance, adequacy, clarity, and internal reliability of the instrument's items were assessed by a multidisciplinary judges committee (JC) through the E-surv web platform, obtaining an average agreement of ≥0.91. The understanding of the instrument measured by the target population revealed adequate clarity with a coefficient average of 0.96. CONCLUSION EmpoderACO can aid in qualifying the communication process between medical professionals and patients, as well as in improving adherence to both treatment and clinical outcomes, and can be replicated in healthcare settings.
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Affiliation(s)
- Hannah Cardoso Barbosa
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Heloisa de Carvalho Torres
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | | | | | - Josiane Moreira da Costa
- Universidade Federal dos Vales do Jequitinhonha e MucuriTeófilo OtoniMGBrasilUniversidade Federal dos Vales do Jequitinhonha e Mucuri, Teófilo Otoni, MG – Brasil
| | - Leonardo Gonçalves Miranda
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Adriana Silvina Pagano
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Marcus Fernando da Silva Praxedes
- Universidade Federal do Recôncavo da BahiaCruz das AlmaBABrasilUniversidade Federal do Recôncavo da Bahia (UFRB), Cruz das Almas, BA – Brasil
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Valery JR, Marar A, Pujalte G, Ward C, Abdelmoneim YM, Fitzgerald PJ, Mwakyanjala E, Harris DM, Murray L, Heckman MG, White LJ, Stancampiano F. Assessment of Knowledge Regarding Risks and Benefits of the Use of Non-Vitamin K Antagonist Oral Anticoagulants. J Prim Care Community Health 2022; 13:21501319221118806. [PMID: 36000450 PMCID: PMC9424872 DOI: 10.1177/21501319221118806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-vitamin K antagonist oral anticoagulants (NOAC) have replaced vitamin K antagonist (VKA) oral anticoagulants as the first-line treatment option for stroke prevention in high-risk patients with atrial fibrillation. With VKA therapy, disease and treatment-related knowledge is associated with improved adherence and outcomes. There is concern that due to the lack of need for ongoing visits for laboratory monitoring in patients on NOACs, there is less opportunity for education, leading to poor disease- and treatment-related knowledge in this patient group. METHODS One hundred ninety-nine (199) patients presenting to 2 primary care clinics on NOAC therapy were surveyed regarding atrial fibrillation and their knowledge regarding NOACs. Chart review was completed to determine patient characteristics and data obtained was compared with survey results to determine the accuracy of the survey responses. RESULTS Patients with a lower degree of NOAC knowledge tended to be older (P < .001), have higher Charlson Comorbidity Index scores (P = .001), use apixaban more often (P = .008), and have been on NOACs for a shorter time period (P = .007). CONCLUSIONS There is an opportunity to improve NOAC-related knowledge in patients with atrial fibrillation. When developing educational interventions, patient characteristics associated with poor knowledge should be considered. Based on our results, these are patients who are older, more medically complex, are on apixaban, and have been on NOAC therapy for a shorter duration.
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Affiliation(s)
- Jose Raul Valery
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Ahmad Marar
- University of Florida College of Pharmacy, Gainesville, FL, USA
| | - George Pujalte
- Division of Family Medicine, and Orthopedics, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Cynthia Ward
- Primary Care Pharmacy, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Yousif M Abdelmoneim
- Division of Laboratory Medicine and Pathology Mayo Clinic Florida, Jacksonville, FL, USA
| | - Patrick J Fitzgerald
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Edson Mwakyanjala
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Dana M Harris
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Loren Murray
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Launia J White
- Division of Clinical Trials and Biostatistics, Mayo Clinic Florida, Jacksonville, FL, USA
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3
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Cabellos-García AC, Martínez-Sabater A, Díaz-Herrera MÁ, Gea-Caballero V, Castro-Sánchez E. Health literacy of patients on oral anticoagulation treatment- individual and social determinants and effect on health and treatment outcomes. BMC Public Health 2021; 21:1363. [PMID: 34243749 PMCID: PMC8272331 DOI: 10.1186/s12889-021-11259-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 06/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Assessment health literacy in people with cardiovascular health problems would facilitate the development of appropriate health strategies for the care and reduction of complications associated with oral anticoagulation therapy. Aim: To evaluate the relationship between health literacy and health and treatment outcomes (concordance with oral anticoagulants, Normalized Ratio control and occurrence of complications) in patients with cardiovascular pathology. Methods Observational, analytic and cross-sectional study carried out on 252 patients with cardiovascular pathology (atrial fibrillation, flutter or valve prosthesis), aged 50–85 years, accessing primary care services in Valencia (Spain) in 2018–2019. Variables referring to anticoagulant treatment with vitamin K antagonists (years of treatment, adequate control, polypharmacy and occurrence of complications, among others) and health literacy (Health Literacy Questionnaire) were analysed. Results All dimensions of health literacy were significantly related to the level of education (p < 0.02), social class (p < 0.02), an adequate control of acenocoumarol (p < 0.001), frequentation of health services (p < 0.001), information by patients to health professionals about anticoagulant treatment (p < 0.03), emergency care visits (p < 0.001) and unscheduled hospital admissions (p < 0.001). Conclusion Health literacy has a relevant influence on the adequate self-management of anticoagulation treatment and the frequency of complications. The different dimensions that comprise health literacy play an important role, but the “social health support” dimension seems to be essential for such optimal self-management. Trial registration ACC-ACE-2016-01. Registration date: December 2015.
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Affiliation(s)
- Ana Cristina Cabellos-García
- Hospital Universitario y politécnico La Fe, Valencia, Spain.,Health Research Institut La Fe, Research Group GREIACC, Valencia, Spain
| | - Antonio Martínez-Sabater
- Nursing Department, Universitat de València, Valencia, Spain. .,Facultat d'Infermeria i Podologia. Nursing Care and Education Research Group. (GRIECE). Grupo Investigación en Cuidados (INCLIVA), Hospital Clínico Universitario, Valencia, Spain.
| | - Miguel Ángel Díaz-Herrera
- Direcció d'Atenció Primaria Costa Ponent, Institut Català de la Salut, Avinguda de la Gran via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08940, Cornellà de Llobregat, Spain
| | - Vicente Gea-Caballero
- Health Research Institut La Fe, Research Group GREIACC, Valencia, Spain.,Escuela de Enfermería La Fe, centre affiliated to Universitat de Valencia, Valencia, Spain
| | - Enrique Castro-Sánchez
- School of Health Sciences, University of London, London, UK.,National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
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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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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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Salmasi S, Kapanen AI, Kwan L, Andrade JG, De Vera MA, Loewen P. Atrial fibrillation patients' experiences and perspectives of anticoagulation therapy changes. Res Social Adm Pharm 2020; 16:1409-1415. [PMID: 31983624 DOI: 10.1016/j.sapharm.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/02/2020] [Accepted: 01/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) patients' experiences with changes in their oral anticoagulant (OAC) therapy are understudied. OBJECTIVE The objective of this study was to qualitatively describe AF patients' experiences and perspectives of changes made to their OAC therapy (switches or discontinuations). METHODS A thematic analysis was performed on systematically-collected qualitative data from AF patients who experienced a therapy change (switching or discontinuing an OAC) as part of their participation in a large 2-year prospective observational study. RESULTS A total of 56 participants met the inclusion criteria. Six themes emerged from the data: 1. reasons for switch or discontinuation of therapy, 2. attitudes towards changes in therapy attributes, 3. challenges with taking medications after therapy change, 4. relief from perceived burden of medication after discontinuation, 5. patients' limited involvement in decision-making, and 6. inadequate education and follow up. Patients were found to request changes in therapy based on their subjective experience with it (rather than clinically justified reasons). They were found to have limited knowledge about their medications, differing reactions to changes in their therapy attributes after a switch, an overall negative attitude towards taking medications, adherence challenges after switching from once daily to twice daily medication, feelings of being excluded from the decision-making process about their therapy changes and feelings of being unsupported after these changes. CONCLUSIONS There are clear opportunities to improve patients' experiences with OAC therapy changes through improved shared decision-making and patient education/counselling.
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Affiliation(s)
- Shahrzad Salmasi
- Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Vancouver, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Anita I Kapanen
- Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Vancouver, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Leanne Kwan
- Atrial Fibrillation Clinic, Royal Columbian Hospital, New Westminster, Canada
| | - Jason G Andrade
- Atrial Fibrillation Clinic, Vancouver General Hospital, Vancouver, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mary A De Vera
- Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Vancouver, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Peter Loewen
- Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Vancouver, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
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7
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Salmasi S, De Vera MA, Barry A, Bansback N, Harrison M, Lynd LD, Loewen PS. Assessment of Condition and Medication Knowledge Gaps Among Atrial Fibrillation Patients: A Systematic Review and Meta-analysis. Ann Pharmacother 2019; 53:773-785. [DOI: 10.1177/1060028019835845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Patient education facilitates construction of a correct illness representation, improves beliefs about medications, and improves knowledge, factors that have been associated with better adherence. Objective: Our objective was to characterize the published literature about atrial fibrillation (AF) patients’ disease and medication knowledge to identify knowledge gaps and misconceptions to inform AF patient education strategies. Methods: Following PRISMA guidelines, we searched PubMed, EMBASE, CINAHL, and PsychINFO from inception to May 2018 for studies that assessed AF patients’ knowledge about their condition and medications. For quantitative studies, we extracted the proportion of participants who provided correct answers to the questions asked about their condition, medications, or risk of stroke. We classified data for related questions into knowledge domains. A random-effects meta-analysis was conducted for each knowledge domain. A domain was considered a knowledge gap if the pooled mean proportion of participants who demonstrated knowledge of it was ≤50%, regardless of CI. Qualitative data were summarized narratively. Results: A total of 21 studies were included. AF- and stroke-related knowledge gaps and misconceptions included the following: AF can be asymptomatic, AF can predispose to heart failure, women are at a higher risk of stroke, the definition of ischemic stroke, and patients’ awareness of their diagnosis. Medication-related knowledge gaps were antithrombotic-drug interactions, antithrombotic-food interactions, vitamin K content of foods, the term INR (international normalized ratio) and its interpretation, and the required actions in case of a missed dose. Conclusion and Relevance: This systematic review identified several AF patient knowledge gaps about their condition and its treatment that can inform the development of AF patient education programs.
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Affiliation(s)
| | | | - Arden Barry
- University of British Columbia, Vancouver, BC, Canada
- Chilliwack General Hospital, BC, Canada
| | - Nick Bansback
- University of British Columbia, Vancouver, BC, Canada
- Providence Health Research Institute, Vancouver, BC, Canada
| | - Mark Harrison
- University of British Columbia, Vancouver, BC, Canada
- Providence Health Research Institute, Vancouver, BC, Canada
| | - Larry D. Lynd
- University of British Columbia, Vancouver, BC, Canada
- Providence Health Research Institute, Vancouver, BC, Canada
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Ulrich LR, Petersen JJ, Mergenthal K, Berghold A, Pregartner G, Holle R, Siebenhofer A. Cost-effectiveness analysis of case management for optimized antithrombotic treatment in German general practices compared to usual care - results from the PICANT trial. HEALTH ECONOMICS REVIEW 2019; 9:4. [PMID: 30729350 PMCID: PMC6734317 DOI: 10.1186/s13561-019-0221-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/27/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND By performing case management, general practitioners and health care assistants can provide additional benefits to their chronically ill patients. However, the economic effects of such case management interventions often remain unclear although how to manage the burden of chronic disease is a key question for policy-makers. This analysis aimed to compare the cost-effectiveness of 24 months of primary care case management for patients with a long-term indication for oral anticoagulation therapy with usual care. METHODS This analysis is part of the cluster-randomized controlled Primary Care Management for Optimized Antithrombotic Treatment (PICANT) trial. A sample of 680 patients with German statutory health insurance was initially considered for the cost analysis (92% of all participants at baseline). Costs included all disease-related direct health care costs from the payer's perspective (German statutory health insurers) plus case management costs for the intervention group. A-Quality Adjusted Life Year (QALY) measurement (EQ-5D-3 L instrument) was used to evaluate utility, and incremental cost-effectiveness ratio (ICER) to assess cost-effectiveness. Mean differences were calculated and displayed with 95%-confidence intervals (CI) from non-parametric bootstrapping (1000 replicates). RESULTS N = 505 patients (505/680, 74%) were included in the cost analysis (complete case analysis with a follow-up after 12 and 24 months as well as information on cost and QALY). After two years, the mean difference of direct health care costs per patient (€115, 95% CI [- 201; 406]) and QALYs (0.03, 95% CI [- 0.04; 0.11]) in the two groups was small and not significant. The costs of case management in the intervention group caused mean total costs per patient in this group to rise significantly (mean difference €503, 95% CI [188; 794]). The ICER was €16,767 per QALY. Regardless of the willingness of insurers to pay per QALY, the probability of the intervention being cost-effective never rose above 70%. CONCLUSIONS A primary care case management for patients with a long-term indication for oral anticoagulation therapy improved QALYs compared to usual care, but was more costly. However, the results may help professionals and policy-makers allocate scarce health care resources in such a way that the overall quality of care is improved at moderate costs, particularly for chronically ill patients. TRIAL REGISTRATION Current Controlled Trials ISRCTN41847489 .
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Affiliation(s)
- Lisa R. Ulrich
- 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
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Rolf Holle
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, 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 of Graz, Graz, Austria
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Cabellos-García AC, Martínez-Sabater A, Castro-Sánchez E, Kangasniemi M, Juárez-Vela R, Gea-Caballero V. Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review. BMC Public Health 2018; 18:1157. [PMID: 30286744 PMCID: PMC6172776 DOI: 10.1186/s12889-018-6070-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Oral anticoagulants (OAC) are widely used in patients with cardiovascular diseases. However, for optimal OAC self-care patients must have skills, among which health literacy (HL) is highlighted. We aimed to describe the relation between HL and self-care in cardiovascular patients on OAC treatment. METHODS Electronic searches were carried out in the PubMed, Scopus, Embase, CINAHL, Web of Science, Cochrane Library, SciELO, IME-Biomedicina, CUIDEN Plus and LILACS databases, limited to Spanish and English language and between January 2000-December 2016. Papers reported on adults older than 18 years, taking OAC by themselves for at least three months. PRISMA guidelines were used for paper selection. RESULTS We identified 142 articles and finally included 10; almost all of them about warfarin. Our results suggest that in patients taking OAC treatments there is a positive relationship between HL and the level of knowledge. In addition, a small percentage of participants on the selected papers recognized the side effects and complications associated with OAC treatment. Lower HL level was associated with greater knowledge deficits and less adherence to treatment. CONCLUSION There is a paucity of research evaluating the effect of HL on diverse aspects of OAC treatments. There is a need to expand the evidence base regarding appropriate HL screening tools, determinants of adequate knowledge and optimal behaviours related to OAC self-management.
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Affiliation(s)
| | | | - Enrique Castro-Sánchez
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Du Cane Road, W12 0NN, London, UK
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Raul Juárez-Vela
- Universidad San Jorge de Zaragoza, Villanueva de Gállego, Zaragoza, Spain
| | - Vicente Gea-Caballero
- Escuela de Enfermería La Fe, centro adscrito Universidad de Valencia, Valencia, Spain
- Instituto de Investigación La Fe. Grupo de investigación GREIACC, Valencia, Spain
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10
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Kaufman BG, Kim S, Pieper K, Allen LA, Gersh BJ, Naccarelli GV, Ezekowitz MD, Fonarow GC, Mahaffey KW, Singer DE, Chan PS, Freeman JV, Ansell J, Kowey PR, Rieffel JA, Piccini J, Peterson E, O'Brien EC. Disease understanding in patients newly diagnosed with atrial fibrillation. Heart 2018; 104:494-501. [PMID: 28790169 PMCID: PMC5861387 DOI: 10.1136/heartjnl-2017-311800] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe self-reported disease understanding for newly diagnosed patients with atrial fibrillation (AF) and assess (1) how disease understanding changes over the first 6 months after diagnosis and (2) the relationship between patient understanding of therapies at baseline and treatment receipt at 6 months among treatment-naïve patients. METHODS We analysed survey data from SATELLITE (Survey of Patient Knowledge and Personal Priorities for Treatment), a substudy of patients with new-onset AF enrolled in the national Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT) II registry across 56 US sites. Patients were surveyed at the baseline and 6-month follow-up clinic visits using Likert scales. RESULTS Among 1004 baseline survey responses, patients' confidence in their understanding of rhythm control, ablation, anticoagulation and cardioversion was suboptimal, with 'high' understanding ranging from 8.5% for left atrial appendage closure to 71.3% for rhythm therapy. Of medical history and demographic factors, education level was the strongest predictor of reporting 'high' disease understanding. Among the 786 patients with 6-month survey data, significant increases in the proportion reporting high understanding were observed (p<0.05) only for warfarin and direct oral anticoagulants (DOACs). With the exception of ablation, high understanding for a given therapeutic option was not associated with increased use of that therapy at 6 months. CONCLUSIONS About half of patients with new-onset AF understood the benefits of oral anticoagulant at the time of diagnosis and understanding improved over the first 6 months. However, understanding of AF treatment remains suboptimal at 6 months. Our results suggest a need for ongoing patient education. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov. Identifier: NCT01701817.
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Affiliation(s)
| | - Sunghee Kim
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Karen Pieper
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Larry A Allen
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | - Gregg C Fonarow
- Division of Cardiology, University of California, Los Angeles, California, USA
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, School of Medicine, Stanford, California, USA
| | - Daniel E Singer
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul S Chan
- Department of Cardiovascular Research, St. Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - James V Freeman
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jack Ansell
- Hofstra Northwell School of Medicine, New York, New York, USA
| | - Peter R Kowey
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | | | | | - Eric Peterson
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Emily C O'Brien
- Duke Clinical Research Institute, Durham, North Carolina, USA
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11
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Patients' knowledge on oral anticoagulant treatment in Hungary. Int J Clin Pharm 2017; 39:1265-1272. [PMID: 29052116 DOI: 10.1007/s11096-017-0544-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/06/2017] [Indexed: 11/27/2022]
Abstract
Background A key element for an effective and safe oral anticoagulant treatment (OAT) is to have the relevant information delivered to patients in an easy-to-understand way and thus have them apply this knowledge in their own therapy. Objective To assess knowledge about OAT, reveal knowledge gaps and identify at-risk patients in terms of limited knowledge about their anticoagulant therapy. Setting Community pharmacies in Hungary. Methods This descriptive cross-sectional study used a structured, validated, self-developed questionnaire to assess patients' knowledge about OAT. Scores were calculated on each domain and the association between knowledge and patients' or treatment characteristics were analysed. Responses in all domains were assessed to identify at-risk patients and knowledge gaps. Main outcome measures Knowledge and knowledge gaps on OAT, and risk factors for limited knowledge. Results The questionnaire developed based on four validated questionnaires passed the field test and had a good internal consistency (Cronbach α = 0.795). Our full patient population (N = 427) had a mean percentage score of 59.39 (29.7% good, 41.2% average, 29.0% poor knowledge on OAT). Poor knowledge level was found to significantly correlate with advanced age (> 75 years), lower education, diagnosis of atrial fibrillation, and unawareness of the indication of OAT. The lowest frequency of correct answers regarded the questions on drug interactions (10.2%) and diet (11.4%). Pharmacists were infrequently indicated as the healthcare professionals to share information with regarding OAT (12.7%). Conclusion Findings of our study offer a valuable insight into the required directions of developing new strategies for patient education to improve knowledge on the treatment with oral anticoagulants.
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Biteker M, Başaran Ö, Doğan V, Altun İ, Özpamuk Karadeniz F, Tekkesin Aİ, Çakıllı Y, Türkkan C, Hamidi M, Demir V, Gürsoy MO, Tek Öztürk M, Aksan G, Seyis S, Ballı M, Alıcı MH, Bozyel S. Real-World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl-life Multicenter Survey Evaluating Stroke Study. J Am Geriatr Soc 2017; 65:1684-1690. [PMID: 28394435 DOI: 10.1111/jgs.14855] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Murat Biteker
- Department of Cardiology; Faculty of Medicine; Mugla Sitki Kocman University; Mugla Turkey
| | - Özcan Başaran
- Department of Cardiology; Faculty of Medicine; Mugla Sitki Kocman University; Mugla Turkey
| | - Volkan Doğan
- Department of Cardiology; Faculty of Medicine; Mugla Sitki Kocman University; Mugla Turkey
| | - İbrahim Altun
- Department of Cardiology; Faculty of Medicine; Mugla Sitki Kocman University; Mugla Turkey
| | | | - Ahmet İlker Tekkesin
- Department of Cardiology; Siyami Ersek Heart Education and Research Hospital; Istanbul Turkey
| | - Yasin Çakıllı
- Department of Cardiology; Tuzla State Hospital; Istanbul Turkey
| | - Ceyhan Türkkan
- Department of Cardiology; Siyami Ersek Heart Education and Research Hospital; Istanbul Turkey
| | - Mehmet Hamidi
- Department of Cardiology; Bandırma State Hospital; Bandırma Turkey
| | - Vahit Demir
- Department of Cardiology; Yozgat State Hospital; Yozgat Turkey
| | | | - Müjgan Tek Öztürk
- Department of Cardiology; Ankara Keçiören Education and Research Hospital; Ankara Turkey
| | - Gökhan Aksan
- Department of Cardiology; Şişli Hamidiye Etfal Education and Research Hospital; Istanbul Turkey
| | - Sabri Seyis
- Department of Cardiology; Mersin Private Dogus Hospital; Mersin Turkey
| | - Mehmet Ballı
- Department of Cardiology; Mersin Toros State Hospital; Mersin Turkey
| | - Mehmet Hayri Alıcı
- Department of Cardiology; Gaziantep be Aralık State Hospital; Gaziantep Turkey
| | - Serdar Bozyel
- Department of Cardiology; Kocaeli Derince Education and Research Hospital; Kocaeli Turkey
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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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Thomson Mangnall LJ, Sibbritt DW, Al-Sheyab N, Gallagher RD. Predictors of warfarin non-adherence in younger adults after valve replacement surgery in the South Pacific. HEART ASIA 2016; 8:18-23. [PMID: 27347009 DOI: 10.1136/heartasia-2016-010751] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/11/2016] [Accepted: 05/17/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Globally, mechanical valves are predominant as replacements for adolescents and younger adults with rheumatic heart disease (RHD). Mechanical valve implantation necessitates lifelong antithrombotic management (warfarin) and associated lifestyle modification, with event-free survival largely dependent on international normalised therapeutic ratios (INRs) remaining within the target therapeutic range. There is limited information on factors that may influence warfarin adherence among younger people or those in resource-limited settings. This study sought to identify predictors of warfarin adherence after valve replacement surgery for RHD in Fiji (n=127). METHODS A cross-sectional study design was used. RESULTS The sample had a mean age of 31.23 years (SD 13.34) and a mean time-since-surgery of 3.72 years (SD 3.95). Just over half were women (n=71, 56%) and almost two-thirds were indigenous (I-taukei, n=78, 61%). Most had an isolated valve procedure (n=94, 74%) and at the time of survey, they were in New York Heart Association Class I (n=97, 76%). A quarter (n=33, 26%) reported poor adherence with anticoagulation therapy and 13.38% (n=17) reported complete warfarin cessation. While younger age was significantly associated with non-adherence to warfarin therapy (p=0.008), the independent predictors of people who discontinue warfarin completely were those not understanding why warfarin was needed (OR=9.97, p=0.006); a history of forgetting to take warfarin (OR=8.64, p=0.0013) and travel time to heart clinic >1 hour (OR=5.80, p=0.039). CONCLUSIONS While medication adherence is complex and multifactorial, the consequences of warfarin non-adherence are potentially catastrophic. These results provide an important first step towards the development of country-specific and disease-specific strategies to improve warfarin adherence.
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Affiliation(s)
- Linda J Thomson Mangnall
- Cardiothoracic Medical and Surgical Telemetry Unit, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia; Faculty of Nursing and Midwifery, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - David W Sibbritt
- Faculty of Health , University of Technology , Sydney, New South Wales , Australia
| | - Nihaya Al-Sheyab
- Faculty of Nursing and Midwifery, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Robyn D Gallagher
- Charles Perkins Centre and Sydney Nursing School, University of Sydney , Camperdown, New South Wales , Australia
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