Health literacy and anticoagulation-related outcomes among patients taking warfarin

Abstract

BACKGROUND: Little is known about whether health literacy affects anticoagulation‐related outcomes. OBJECTIVE: To assess how health literacy is associated with warfarin knowledge, adherence, and warfarin control (measured by the international normalized ratio [INR]). DESIGN: Survey. PARTICIPANTS: Patients taking warfarin through an anticoagulation clinic. MEASUREMENTS: Health literacy was measured using the short‐form Test of Functional Health Literacy in Adults (s‐TOFHLA), dichotomized as “limited” (score 0 to 22) and “adequate” (score 23 to 36). We asked patients to answer questions relating to their warfarin therapy and used multivariable logistic regression to assess whether health literacy was associated with incorrect answers. We also assessed whether health literacy was associated with nonadherence to warfarin as well as time in therapeutic INR range. RESULTS: Bilingual research assistants administered the survey and s‐TOFHLA to 179 anticoagulated English‐ or Spanish‐speaking patients. Limited health literacy was associated with incorrect answers to questions on warfarin's mechanism (adjusted odds ratio [OR] 4.8 [1.3 to 17.6]), side‐effects (OR 6.4 [2.3 to 18.0]), medication interactions (OR 2.5 [1.1 to 5.5]), and frequency of monitoring (OR 2.7 [1.1 to 6.7]), after adjusting for age, sex, race/ethnicity, education, cognitive impairment, and years on warfarin. However, limited health literacy was not significantly associated with missing warfarin doses in 3 months (OR 0.9 [0.4 to 2.0]) nor with the proportion of person‐time in therapeutic INR range (OR 1.0 [0.7 to 1.4]). CONCLUSIONS: Limited health literacy is associated with deficits in warfarin‐related knowledge but not with self‐reported adherence to warfarin or INR control. Efforts should concentrate on investigating alternative means of educating patients on the management and potential risks of anticoagulation.

Association of Health Literacy With Medication Knowledge, Adherence, and Adverse Drug Events Among Elderly Veterans

“…Investigators have described a relation between low health literacy and hypoglycemic events (Sarkar et al, 2010) and the lack of an association between health literacy and anticoagulation control (Fang, Machtinger, Wang, & Schillinger, 2006). However, to our knowledge, no published studies have measured the association between health literacy and ADEs more broadly.…”

The validity and reliability of Turkish version of the Duke anticoagulation satisfaction scale

“…[2,12,13] Yapılan bazı araştırmalarda hastanede yattığı süreçte ve taburculuk sonrasında, hastaların pıhtı-önleyici tedavi yöne-timi, ilaç etkileşimleri ve diyet konusunda bilgilerinin yetersiz olduğu, [1,[14][15][16][17][18][19] K vitamininden zengin beslenen olgularda pıhtı-önler ilaç dozunun etkisinin yetersiz olduğu, [20] hastaların kendilerini ifade etme sürecin-de güven eksikliği duydukları [19] ve kliniğe başvuru ücretleri ve ulaşım masrafları gibi finansal sorunlar yaşadıkları saptanmıştır. [21,22] Hastane randevularına uyumsuzluk, [1,23] hastaneye gitmekten hoşlanmama, laboratuvarlar arası farklı sonuçlar, sevdiği besinleri besin-ilaç etkileşmesi sonucu istediği oranda tüketeme-me, birincil hastalığın yol açtığı fiziksel ve psiko-sosyal sorunlar olarak saptanmıştır. [20,22] Yaş artışı ile birlikte sorunların özellikle de kanama komplikasyonlarının daha fazla yaşandığı, [24] pıhtı-önleyici tedaviyi yönete-medikleri ve polifarmasi sorunu yaşadıkları bildirilmiş-tir.…”

“…[25,26] Bu hasta grubunda inmenin fazla görüldüğü ve hastaların %43'ünün alacağı ilaç dozunu unuttuğu saptanmıştır. [23] Yaşanan sorunlar sosyo-demografik değişkenler (yaş, cinsiyet, gelir durumu, eğitim vb. ), hastalık sürecine ilişkin değişimler (farklı ilaçların kullanılması, hastalık süresi, başka kronik hastalığın varlığı vb.)…”

Patients Perceptions of Medication Counselling from Community Pharmacies

“…Conclusions drawn from a Cochrane review found that the combination of both verbal and written health information improves patients' knowledge and satisfaction [9]. Thus, patient education seems a reasonable way for shaping adherence to medicines [10].…”