Relationship Between Patients’ Warfarin Knowledge and Anticoagulation Control

Tang, Elaine Othilia Y L; Lai, Cemen S M; Lee, Kenneth K. C.; Wong, Raymond; Cheng, Gregory; Chan, T. Y. K.

doi:10.1345/aph.1a198

Cited by 202 publications

(232 citation statements)

References 18 publications

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“…A previous study indicates that knowledge concerning anticoagulants was associated with a reduced risk of bleeding (8) and that written and verbal information helped to improve control of anticoagulant levels (9) .…”

Section: Introductionmentioning

confidence: 99%

Knowledge of Patients with Mechanical Valve Prostheses Concerning Chronic Oral Anticoagulant Therapy

Rocha¹,

Rabelo

Aliti

et al. 2010

Rev. Latino-Am. Enfermagem

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Adherence to chronic Oral Anticoagulant Therapy (OAT) is directly related to patients' understanding of the therapy. This study verified the knowledge of patients with mechanical valve prostheses concerning OAT. This is a contemporary cross-sectional study, the sample is composed of patients with mechanical valve prostheses (MVP) in outpatient follow-up.A 10-question instrument was used; answers were 'know' (1 point), 'know partially' (half point), or 'do not know' (zero). Patients were grouped according to the result obtained: ≤ 4 points was considered insufficient knowledge; > 4 ≤ 8 equated to moderate knowledge; and > 8 was considered appropriate knowledge. Of the 110 patients, 61.8% presented moderate knowledge, 40.9% were not able to name at least one factor that may alter the INR (International Normalized Ratio) and 37.3% were not able to report their INR target range. The majority of patients presented moderate knowledge concerning the treatment.Strategies to improve knowledge on the topic should be implemented to minimize risks. Conocimiento de los pacientes portadores de prótesis valvular mecánica sobre la terapia de anticoagulación oral crónicaEl objetivo de este estudio fue verificar el conocimiento de pacientes con prótesis valvular sobre la terapia de anticoagulación oral. La adhesión a la terapia de anticoagulación oral crónica está directamente relacionada al entendimiento del paciente sobre esta terapia.Se trata de un estudio transversal contemporáneo, en el cual se incluyeron pacientes de ambulatorio con prótesis valvular mecánica (PVM). Se aplicó un cuestionario con 10 preguntas; las respuestas fueron "sabe" (1 punto), "sabe parcialmente" (medio punto), "no sabe" (cero puntos). Los pacientes fueron agrupados según la puntuación obtenida: ≤ 4 puntos, conocimiento insuficiente; > 4 ≤ 8 puntos, conocimiento regular; > 8 puntos, conocimiento adecuado. De los 110 pacientes incluidos, el 61,8% demostró conocimiento regular, 40,9% no supieron citar un factor que altera el REI (razón estandarizada internacional) y 37,3% no supieron informar su REI objetivo. Se concluyó que la mayoría de los pacientes demostró conocimiento regular sobre el tratamiento. Se recomienda implantar estrategias para mejorar el conocimiento y minimizar los riesgos de la terapia.

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Section: Introductionmentioning

confidence: 99%

Knowledge of Patients with Mechanical Valve Prostheses Concerning Chronic Oral Anticoagulant Therapy

Rocha¹,

Rabelo

Aliti

et al. 2010

Rev. Latino-Am. Enfermagem

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“…Patient understanding of the reason for testing may affect test adherence, as suggested by one study of warfarin. 12 Forgetting is known to be a common reason for missing physician appointments, 13,14 but its role in performing laboratory tests is unknown. Health system factors have also been identified as reasons why patients miss appointments.…”

Section: Introductionmentioning

confidence: 99%

Patient Completion of Laboratory Tests to Monitor Medication Therapy: A Mixed-Methods Study

et al. 2012

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BACKGROUND:Little is known about the contribution of patient behavior to incomplete laboratory monitoring, and the reasons for patient non-completion of ordered laboratory tests remain unclear. OBJECTIVE: To describe factors, including patientreported reasons, associated with non-completion of ordered laboratory tests. DESIGN: Mixed-Methods study including a quantitative assessment of the frequency of patient completion of ordered monitoring tests combined with qualitative, semi-structured, patient interviews. PARTICIPANTS: Quantitative assessment included patients 18 years or older from a large multispecialty group practice, who were prescribed a medication requiring monitoring. Qualitative interviews included a subset of show and no-show patients prescribed a cardiovascular, anticonvulsant, or thyroid replacement medication. MAIN MEASURES: Proportion of recommended monitoring tests for each medication not completed, factors associated with patient non-completion, and patientreported reasons for non-completion. KEY RESULTS: Of 27,802 patients who were prescribed one of 34 medications, patient non-completion of ordered tests varied (range: 0-24 %, by drug-test pair). Factors associated with higher odds of test noncompletion included: younger patient age (< 40 years vs. ≥ 80 years, adjusted odds ratio [AOR] 1.52, 95 % confidence interval [95 % CI] 1.27-1.83); lower medication burden (one medication vs. more than one drug, AOR for non-completion 1.26, 95 % CI 1.15-1.37), and lower visit frequency (0-5 visits/year vs. ≥ 19 visits/ year, AOR 1.41, 95 % CI 1.25 to 1.59). Drug-test pairs with black box warning status were associated with greater odds of non-completion, compared to drugs without a black box warning or other guideline for testing (AOR 1.91,. Qualitative interviews, with 16 no-show and seven show patients, identified forgetting as the main cause of non-completion of ordered tests. CONCLUSIONS:Patient non-completion contributed to missed opportunities to monitor medications, and was associated with younger patient age, lower medication burden and black box warning status. Interventions to improve laboratory monitoring should target patients as well as physicians.

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“…A não adesão ao tratamento medicamentoso e a falta de controle na qualidade da anticoagulação são fatores que podem influenciar negativamente na QVRS dos usuários de ACOs (DAVIS et al, 2005;KIMMEL et al, 2007;TANG et al, 2003 (REWIUK et al, 2007).…”

Section: Apresentação E Relevância Do Temaunclassified

“…Outros investigadores também observaram uma associação positiva entre conhecimento do paciente em uso de ACOs e a manutenção do INR na faixa terapêutica (TANG, 2003;van DAMME et al, 2010). Portanto, a identificação do conhecimento dos pacientes em uso de ACO é uma variável importante a ser mensurada em programas de intervenção (LAINSCAK; KEBER, 2005).…”

Section: Apresentação E Relevância Do Temaunclassified

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Efeitos de um programa educativo na qualidade de vida relacionada à saúde e na adesão à terapia de anticoagulação oral: estudo clínico randomizado

Corbi¹

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DEDICATÓRIAExperimental study with random distribution in two groups (Intervention or Control), which assessed the health-related quality of life and medication treatment adherence of patients who were hospitalized to adjust the oral anticoagulation drug dosage, according to their participation in an educational group (Intervention Group -IG) or in routine care (Control Group -CG). The groups were also compared according to their general self-efficacy and presence of anxiety and depression symptoms at two times: upon hospitalization (T 1 ) and two months after discharge from hospital (T 2 ). The study was developed at a public hospital in the interior of São Paulo State, Brazil, from March 2011 till December 2012. In total, 113 patients were considered eligible for the study, randomized between CG (N=58) and IG (N=55). The randomization took place after the patients' stratification into low, medium and high bleeding risk, according to The Outpatient Bleeding Risk Index. The patients who participated in the educative program received individualized orientations, using illustrative material, during the hospitalization. After discharge, the orientations were provided through telephone contact during the first and fourth week. To assess the research variables, the versions of the Duke Anticoagulation Satisfaction Scale, Treatment Adherence Measures, Hospital Anxiety and Depression Scale and General Perceived Self-Efficacy Scale validated for Brazilian Portuguese were used. After two months of monitoring, 44 participants completed the followup in CG (75.8% of participants at T 1 ) and 38 in IG (69.1%). The data were assessed by means of descriptive statistics and comparison of means for the variables of interest between the groups (independent Student's t) and intra-groups (paired Student's t-test), upon the hospitalization and two months after discharge. The significance level adopted was 0.05. When comparing the patient groups that completed the follow-up or not, we found similarities in sociodemographic and clinical variables and related to the oral anticoagulation therapy. These similarities were also observed when comparing the control and intervention groups during the hospitalization. As regards the health-related quality of life, treatment adherence, anxiety and depression symptoms and self-efficacy, the results reveal similarities between CG and IG at T 1 and T 2 , not confirming our study hypotheses for T 2 . At T 2 , the differences in the HRQoL (p=0.65), adherence (p=0.89), anxiety (p=0.20), depression (p=0.27) and selfefficacy (p=0.65) scores could not be confirmed when considering the participation in the educative program. In view of the results obtained in the present study, we conclude that, for patients with previous experience in oral anticoagulation treatment, the educative strategy used was not efficient to improve the selected response variables. From the clinical viewpoint, this result is relevant for the health professionals who deliver care to this population of oral anticoagulation drug user...

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Relationship Between Patients’ Warfarin Knowledge and Anticoagulation Control

Abstract: Patients' warfarin knowledge, a determinant of anticoagulation control, was generally poor. More attention should be given to the education of elderly and illiterate patients.

Cited by 202 publications

References 18 publications

Knowledge of Patients with Mechanical Valve Prostheses Concerning Chronic Oral Anticoagulant Therapy

Knowledge of Patients with Mechanical Valve Prostheses Concerning Chronic Oral Anticoagulant Therapy

Patient Completion of Laboratory Tests to Monitor Medication Therapy: A Mixed-Methods Study

Efeitos de um programa educativo na qualidade de vida relacionada à saúde e na adesão à terapia de anticoagulação oral: estudo clínico randomizado

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