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Alanazi Z, Almutairi N, AlDukkan L, Arafat AA, Albabtain MA. Time in therapeutic range for virtual anticoagulation clinic versus in-person clinic during the COVID-19 pandemic: a crossover study. Ann Saudi Med 2022; 42:305-308. [PMID: 36252144 PMCID: PMC9557787 DOI: 10.5144/0256-4947.2022.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND COVID-19 infection affects the quality of the medical services globally. The pandemic required changes to medical services in several institutions. We established a virtual clinic for anticoagulation management during the pandemic using the Whatsapp application. OBJECTIVES Compare anticoagulation management quality in virtual versus in-person clinics. DESIGN A retrospective crossover study SETTINGS: Specialized cardiac care center PATIENTS AND METHODS: The study included patients who presented to Prince Sultan Cardiac Center in Riyadh for anticoagulation management during the pandemic from March 2020 to January 2021. We compared time in therapeutic range (TTR) in the same patients during virtual and in-person clinics. All international normalized ratio (INR) measures during the virtual clinic visits and prior ten INR measures from the in-person clinic were recorded. Patients who had no prior follow-up in the in-person clinic were excluded. MAIN OUTCOME MEASURE TTR calculated using the Rosendaal method. SAMPLE SIZE 192 patients RESULTS: The mean age was 58.6 (16.6) years and 116 (60.4%) were males. Patients were diagnosed with atrial fibrillation (n=101, 52.6%), mechanical mitral valve (n=88, 45.8%), mechanical aortic valve (n=79, 41%), left ventricular thrombus (n=5, 2.6%) and venous thromboembolism (n=8, 4.2%). Riyadh residents represented 56.7% of the study population (n=93). The median (IQR) percent TTR was 54.6 (27.3) in the in-person clinic versus 50.0 (33.3) (P=.07). CONCLUSION Virtual clinic results were comparable to in-person clinics for anticoagulation management during the COVID-19 pandemic. LIMITATIONS Number of INR measures during the virtual clinic visits, retrospective nature and single-center experience. CONFLICT OF INTEREST None.
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Affiliation(s)
- Zaid Alanazi
- From the Department of Pharmacy, Clinical Pharmacy Division, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Nawaf Almutairi
- From the Department of Pharmacy, Clinical Pharmacy Division, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Latifah AlDukkan
- From the Department of Pharmacy, Clinical Pharmacy Division, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Amr A Arafat
- From the Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Gharbiya, Egypt.,From the Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Monirah A Albabtain
- From the Department of Pharmacy, Clinical Pharmacy Division, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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Pharmacist-Facilitated Interactive E-Learning for Patients Newly Initiated on Warfarin: A Randomised Controlled Study. PHARMACY (BASEL, SWITZERLAND) 2021; 10:pharmacy10010003. [PMID: 35076593 PMCID: PMC8788505 DOI: 10.3390/pharmacy10010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 01/31/2023]
Abstract
It is not known whether electronic-learning (e-learning) is effective for educating hospital inpatients about complex medications such as warfarin. This prospective randomised controlled study compared pharmacist-facilitated e-learning with standard pharmacist-delivered face-to-face education on patients’ or their unpaid carers’ knowledge of warfarin and satisfaction with warfarin education as well as the time that was spent by pharmacists in delivering warfarin education. Adult English-speaking patients (or their carers) who had been prescribed warfarin were randomised to receive standard pharmacist face-to-face education (control) or an e-learning module on a tablet device facilitated by a pharmacist (intervention). All of the participants received written warfarin information and were presented with the opportunity to ask any questions that they may have had to a pharmacist. Fifty-four participants completed the study (27 per group). The participants who received e-learning had median correct Oral Anticoagulation Knowledge (OAK) test scores of 85% compared to 80% for standard education (p = 0.14). The participants in both groups were satisfied with the information that they received. There was a trend towards pharmacists spending less time on warfarin education for the e-learning group than in the standard education group (25.5 vs. 33 min, respectively, p = 0.05). Education delivered via pharmacist-facilitated e-learning was non-inferior in terms of patient or carer warfarin knowledge compared to standard pharmacist-delivered education.
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Alajami HN, Alshammari SA, Al-Dossari DS, Alajmi AN, Alsaikhan AS, Alessa MS, Alessa HS, Khalaf Alhothaly S, Alnami MI, Atey TM, Alnajrani RH, Ali S. Knowledge of Anticoagulation Among Saudi Patients With Atrial Fibrillation: A Cross-Sectional Study. Cureus 2021; 13:e19237. [PMID: 34877214 PMCID: PMC8641793 DOI: 10.7759/cureus.19237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background Knowledge about oral anticoagulant treatment can impact treatment outcomes in patients with atrial fibrillation. However, evidence is scarce regarding the knowledge of oral anticoagulants among Saudi patients with atrial fibrillation. Hence, this study aimed to assess the level of anticoagulation knowledge among patients with atrial fibrillation taking oral anticoagulants. Methodology A survey using a cross-sectional study design was conducted among patients with a confirmed diagnosis of atrial fibrillation in a tertiary care setting. The Oral Anticoagulation Knowledge Tool (AKT), a 33-item, self-administered questionnaire, was used to assess the knowledge of anticoagulation. Results A total of 290 patients with a median age of 67 years participated in the survey. More than half of those surveyed (56.2%) were females. Overall, 195 (67.2%) patients had an overall adequate anticoagulation knowledge. The median knowledge score of participants on warfarin was significantly higher than those on direct-acting oral anticoagulants (p < 0.001). Only age was found to be a predictor of AKT. Increasing age was associated with fewer odds of adequate AKT. For every one-year increase in age, the knowledge score decreased by 0.08 (95% confidence interval: -0.13 to -0.04). Conclusions This study found significant knowledge gaps among Saudi patients with atrial fibrillation taking oral anticoagulants. Advancing age was inversely associated with oral anticoagulation knowledge.
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Affiliation(s)
- Hamdan N Alajami
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, SAU
| | - Sulaiman A Alshammari
- Family and Community Medicine, King Saud University, College of Medicine, Riyadh, SAU
| | - Dalal S Al-Dossari
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, SAU
| | - Abdullah N Alajmi
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | - Maha S Alessa
- College of Dentistry, King Saud University, Riyadh, SAU
| | | | | | - Mohammed I Alnami
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, SAU
| | - Tesfay M Atey
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, AUS
- School of Pharmacy, Mekelle University, Tigray, ETH
| | - Rashid H Alnajrani
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, SAU
| | - Sheraz Ali
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, AUS
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4
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Does telehealth improve anticoagulation management in patient service centers (PSC)? A pilot project. J Thromb Thrombolysis 2020; 49:316-320. [PMID: 31898275 DOI: 10.1007/s11239-019-02031-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Anticoagulation Management Services (AMS) are known to improve warfarin management in the outpatient setting. The guideline recommendations are well established and indicate that patients who receive a Vitamin K antagonist (VKA) should be under the care of an experienced and specialized anticoagulation clinic (Lip et al. in Chest 154(5):1121-1201, 2018). Warfarin, a VKA, is considered a high risk medication and one of the most common causes of adverse events with poor patient outcomes. Anticoagulation care is assessed by measuring the percent of Time in Therapeutic Range (TTR) in patients receiving a VKA. Evidence shows that a 10% improvement in TTR has been associated with a 10% reduction in adverse event rates. Optimal management over usual medical care should prevent 7 myocardial infarctions, strokes, major bleeds, or deaths per 100 patients/year (Bussey et al. in Pharmacotherapy 9(4):214-219, 1989). Telehealth or telemedicine can be defined as the use of electronic information along with telecommunication technologies to provide medical services to individuals that are in remote locations from each other (Perednia in JAMA 273(6):483-488, 1995; Gray et al in J Thromb Thrombolysis 2019(48):690-693, 2019). This technology allows a provider located at a distant site to use two-way audio visual electronic communication to deliver clinical health care services to a patient who is located at an originating site (Kristian et al. Int J Technol Assess Health Care 28(1):44-51, 2012; Testa and Zimmermann in Telemedicine for managing patients on oral anticoagulant, 2011; Telehealth Services in CMS Manual System Pub 100-04 medicare claims processing, 2019). The goals of the Telehealth Anticoagulation Management Service are to: (1) increase patient satisfaction (2) reduce turnaround time for results by providing the INR (International Normal Ratio) results in real time (3) increase patient compliance to INR testing and (4) improve system wide anticoagulation care by increasing cTTR (center Time in Therapeutic Range) metrics to high quality metrics of 65% and above. The overarching goal of our health system Telehealth program was to develop a collaborative care telemedicine INR model in collaboration with core laboratories (Patient Service Centers or PSCs) in order to improve patient quality metrics on warfarin. In this model, the Tele-ACTS Center (Telehealth Anticoagulation and Clinical Thrombosis Service) team was able to provide distant care for the outpatient population on warfarin maintenance therapy using a virtual telemedicine INR model located in a distant location to the PSC. Using this model, we were able to improve center-based TTR by 45.73%.
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Kynoch K, Ramis MA, Crowe L, Cabilan CJ, McArdle A. Information needs and information seeking behaviors of patients and families in acute healthcare settings: a scoping review. ACTA ACUST UNITED AC 2020; 17:1130-1153. [PMID: 31192898 DOI: 10.11124/jbisrir-2017-003914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The objective of this scoping review was to explore the information needs and information seeking behaviors of patients and families from healthcare providers in acute healthcare settings in existing literature. INTRODUCTION A well-informed family can be crucial to a patient's capacity to cope with their diagnosis and hospital care during acute or chronic illness. Information is therefore critical to both the patient's and family's understanding of the illness and healthcare process. Providing appropriate and timely information can empower patients and families with knowledge and alleviate the anxiety and stress associated with a hospital admission. However, acutely ill patients and families in different acute care settings have considerable and differing information needs. INCLUSION CRITERIA This scoping review included studies undertaken in acute healthcare facilities where patients were over 18 years of age and family members were of any sex, culture and ethnicity. Family was defined as anyone connected to the patient by blood, marriage or other significant relationship. Healthcare provider perspectives of family and patient information needs were excluded. Concepts related to type of information, timing of information, preferences for who delivers the information and method of information delivery. Qualitative and quantitative study designs published from 2010 to 2017 in English were included. METHODS Multiple databases were searched to find published and unpublished studies. A three-step search strategy was utilized. A charting table was developed for the data extraction process to record data relating to the review objectives. Specific data extracted included details on research design, geographical location, year of publication, characteristics of study population, research aims and outcomes as well as key findings related to patient and family information needs. RESULTS The scoping review included 109 studies from across 34 countries. Of these studies, 68 used quantitative research designs, 29 were qualitative in nature and 12 included studies reported using mixed methods. One study used an action research methodology. Nine studies were specific to family information needs. A majority of studies were conducted in the cancer care context, with other acute settings comprising intensive care units, surgical settings and individual medical or surgical units/wards within and across the hospital. While most of the included studies addressed the type of content patients and/or families prefer, a few studies explored the timing of information provision. CONCLUSIONS The international literature on information needs of patient and families comprises multiple published studies on differing aspects of the topic and situated within various acute care contexts. Despite the broad nature of the research, studies suggest that preferences regarding information content, timing of information delivery and choices regarding who delivers information vary across contexts and according to the patient/family member. The complexity behind this variation and strategies to address tailoring information delivery requires further in-depth research.
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Affiliation(s)
- Kate Kynoch
- Evidence in Practice Unit, Mater Misericordiae Limited, South Brisbane, Australia.,The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
| | - Mary-Anne Ramis
- Evidence in Practice Unit, Mater Misericordiae Limited, South Brisbane, Australia.,The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
| | - Linda Crowe
- Evidence in Practice Unit, Mater Misericordiae Limited, South Brisbane, Australia.,The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
| | | | - Annie McArdle
- Parent Education and Support Services, Mater Mothers' Hospital, South Brisbane, Australia
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Cao H, Wu T, Chen W, Fu J, Xia X, Zhang J. The effect of warfarin knowledge on anticoagulation control among patients with heart valve replacement. Int J Clin Pharm 2020; 42:861-870. [PMID: 32410208 DOI: 10.1007/s11096-020-01043-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Abstract
Background Although novel oral anticoagulants have been applied into clinical practice, warfarin remains the only approved oral anticoagulant for heart valve replacement. Currently, an increasing number of Chinese clinical pharmacists provide patients with warfarin education. However, little research to date has been carried out to evaluate the relationship between warfarin knowledge level and anticoagulation control among patients with heart valve replacement. Objective To evaluate knowledge of warfarin and the relationship between knowledge level and anticoagulation control among patients with heart valve replacement. Setting Fujian Medical University Union Hospital, China. Method A prospective and cross-sectional study was designed to evaluate the warfarin education of inpatients new to warfarin therapy using a validated Anticoagulation Knowledge Assessment questionnaire. Included patients were followed up for at least 3 months. Data were retrieved from hospital databases and telephone follow up. Main outcome measure Spearman's rho correlation analysis was used to assess the relationships between time in therapeutic range and warfarin knowledge level. Results 383 patients were included. The mean age of patients was 50.3 ± 7.9 years. The mean knowledge questionnaire score was 62.3 ± 8.8%. The majority of incorrect answers related to drug-warfarin interaction. Five of the frequently incorrect questions covered drugs, herbs and diet that affect warfarin therapy. There were significant correlations between total questionnaire score and time in therapeutic range (rho = 0.539, P < 0.001), or percentage of international normalized ratio measurements within range (rho = 0.416, P < 0.001). There were significant correlations between patients' educational level and total questionnaire score (rho = 0.357, P = 0.001). No significant correlations were found between income or living area and total questionnaire score (rho = 0.110, P = 0.435; rho = 0.161, P = 0.149). Conclusion Patient knowledge level of anticoagulation therapy affects anticoagulation control. Education for patients new to warfarin and the evaluation of knowledge by validated questionnaire is recommended for better INR control.
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Affiliation(s)
- Hua Cao
- Fujian Maternity and Children Health Hospital, Fuzhou, 350001, China.,Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Tingting Wu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, 350001, China.,College of Pharmacy, Fujian Medical University, Fuzhou, 350108, China
| | - Wenjun Chen
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, 350001, China.,College of Pharmacy, Fujian Medical University, Fuzhou, 350108, China
| | - Jingnan Fu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, 350001, China.,College of Pharmacy, Fujian Medical University, Fuzhou, 350108, China
| | - Xiaotong Xia
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, 350001, China.,College of Pharmacy, Fujian Medical University, Fuzhou, 350108, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, 350001, China. .,College of Pharmacy, Fujian Medical University, Fuzhou, 350108, China.
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Magon A, Arrigoni C, Moia M, Mancini M, Dellafiore F, Manara DF, Caruso R. Determinants of health-related quality of life: a cross-sectional investigation in physician-managed anticoagulated patients using vitamin K antagonists. Health Qual Life Outcomes 2020; 18:73. [PMID: 32178684 PMCID: PMC7077005 DOI: 10.1186/s12955-020-01326-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Literature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients' treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs. METHODS Cross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients' treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions. RESULTS Obtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (ORadjusted = 10.9; 95%CI = 1.99-19.10) and physical (ORadjusted = 11.54; 95%CI = 1.99-34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (ORadjusted = 0.13; 95%CI = 0.03-0.63). Further, age negatively predicted physical health perception (ORadjusted = 0.87; 95%CI = 0.81-0.93). CONCLUSIONS Health literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients' profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.
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Affiliation(s)
- Arianna Magon
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, Italy.
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Marco Moia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Michela Mancini
- Nursing Office, ASST Melegnano e della Martesana, Melzo, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Duilio F Manara
- School of Nursing, Vita-Salute San Raffaele University, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Sommer AE, Golden BP, Peterson J, Knoten CA, O'Hara L, O'Leary KJ. Hospitalized Patients' Knowledge of Care: a Systematic Review. J Gen Intern Med 2018; 33:2210-2229. [PMID: 30238405 PMCID: PMC6258610 DOI: 10.1007/s11606-018-4658-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/12/2018] [Accepted: 08/16/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients' comprehension of their medical conditions is fundamental to patient-centered care. Hospitalizations present opportunities to educate patients but also challenges to patient comprehension given the complexity and rapid pace of clinical care. We conducted a systematic review of the literature to characterize the current state of inpatients' knowledge of their hospitalization, assess the methods used to determine patient comprehension, and appraise the effects of interventions on improving knowledge. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library for articles published from January 1, 1995 through December 11, 2017. Eligible studies included patients under inpatient or observation status on internal medicine, family medicine, or neurology services. We extracted study characteristics (author, year, country, study design, sample size, patient characteristics, methods, intervention, primary endpoints, results) in a standardized fashion. The quality of observational studies was assessed using the NIH Quality Assessment Tool for Observation Cohort and Cross-Sectional Studies and the quality of interventional studies was assessed using adapted EPOC criteria from the Cochrane Collaboration. RESULTS Twenty-eight studies met the criteria for inclusion, including 17 observational studies and 11 interventional studies. Patient knowledge of all aspects of their hospitalization was poor and patients often overestimated their knowledge. Older patients and those with lower education levels were more likely to have poorer knowledge. Intervention methods varied, but generally showed improvements in patient knowledge. Few interventional studies assessed the effect on health behaviors or outcomes and those that did were often underpowered. DISCUSSION Clinicians should be aware that comprehension is often poor among hospitalized patients, especially in those with lower education and advanced age. Our results are limited by overall poor quality of interventional studies. Future research should use objective, standardized measures of patient comprehension and interventions should be multifaceted in approach, focusing on knowledge improvement while also addressing other factors influencing outcomes.
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Affiliation(s)
- Arielle E Sommer
- Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
| | - Blair P Golden
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonna Peterson
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Lyndsey O'Hara
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Bhatt S, McCurdy CE, Liew D, Russell DM. Effect of warfarin education on patient knowledge and anticoagulation control: a randomised controlled trial. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Shireen Bhatt
- Department of General Medicine, The Royal Melbourne Hospital Melbourne Australia
| | | | - Danny Liew
- Monash Centre of Cardiovascular Research and Education in Therapeutics Monash University Melbourne Australia
| | - David M. Russell
- Department of General Medicine, The Royal Melbourne Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
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Magon A, Arrigoni C, Roveda T, Grimoldi P, Dellafiore F, Moia M, Obamiro KO, Caruso R. Anticoagulation Knowledge Tool (AKT): Further evidence of validity in the Italian population. PLoS One 2018; 13:e0201476. [PMID: 30106955 PMCID: PMC6091938 DOI: 10.1371/journal.pone.0201476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/16/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Oral Anticoagulation therapy (OAC) is highly effective in the management of thromboembolic disorders. An adequate level of knowledge is important for self-management and optimizing clinical outcomes. The Anticoagulation Knowledge Tool (AKT) was developed to assess OAC knowledge and caters for both patients prescribed direct oral anticoagulants or vitamin K antagonist (VKA). However, evidence regarding its psychometric proprieties, validity and reliability are unavailable in non-English speaking settings. For this reason, the aim of this study is to provide further evidence of validity for AKT and also developing an Italian AKT version (I-AKT) supported by evidence of validity and reliability. METHODS A multiphase study was conducted which included the following: cultural and linguistic validity; i.e. content validity; construct validity; reliability assessment. The Construct validity was performed using the contrasted group approach using three groups comprised of health care providers, patients and the general public. Furthermore, Exploratory Structural Equation Modelling (ESEM) was performed to confirm the mono-dimensional structure of the items in the AKT. RESULTS In construct validity phase 334 participants were enrolled. One-way ANOVA and post hoc analysis test demonstrated significant differences between the means knowledge scores of the three groups: 30.42±3.04 vs 23.45± 4.57 vs14.32±6.07 (Statistic F = 266.83; p < .001). ESEM analysis demonstrates the I-AKT mono-dimensionally structure with an explained variance of 56.42%. The scale also showed both good internal consistency reliability (Cronbach's α = 0.896) and test-retest reliability (r = 0.855). CONCLUSION This study developed and validated I-AKT with supporting evidence for validity and reliability. The study also confirms the mono-dimensional of the items in the AKT. This suggest that the instrument can be useful in non-English setting for knowledge assessment and in potentially developing patient education materials.
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Affiliation(s)
- Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinic San Donato University Hospital, San Donato Milanese, Milan, Italy
- * E-mail:
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Tiziana Roveda
- Haemostasis and Thrombosis Center, Cardiological Department of ASST Sette Laghi, Galmarini Hospital, Tradate, Varese, Italy
| | - Paola Grimoldi
- Haemostasis and Thrombosis Center, Cardiological Department of ASST Sette Laghi, Galmarini Hospital, Tradate, Varese, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinic San Donato University Hospital, San Donato Milanese, Milan, Italy
| | - Marco Moia
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, University of Milan, IRCCS Ca’ Granda Maggiore Hospital Foundation, Milan, Italy
| | - Kehinde O. Obamiro
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Tasmania, Australia
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinic San Donato University Hospital, San Donato Milanese, Milan, Italy
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Triller D, Myrka A, Gassler J, Rudd K, Meek P, Kouides P, Burnett AE, Spyropoulos AC, Ansell J. Defining Minimum Necessary Anticoagulation-Related Communication at Discharge: Consensus of the Care Transitions Task Force of the New York State Anticoagulation Coalition. Jt Comm J Qual Patient Saf 2018; 44:630-640. [PMID: 30064950 DOI: 10.1016/j.jcjq.2018.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/12/2018] [Accepted: 04/23/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anticoagulated patients are particularly vulnerable to ADEs when they experience changes in medical acuity, pharmacotherapy, or care setting, and resources guiding care transitions are lacking. The New York State Anticoagulation Coalition convened a task force to develop a consensus list of requisite data elements (RDEs) that should accompany all anticoagulated patients undergoing care transitions. METHODS A multidisciplinary panel of 15 anticoagulation experts voluntarily completed an iterative Delphi process. Resources were disseminated and deliberated via remote technology, with consensus achieved via blinded electronic polling. RESULTS The panel reached consensus on a list of 15 RDEs for anticoagulation communication at discharge (the ACDC List). Consensus was rapidly achieved by the full panel on 13 elements, while 3 (2 of which were combined into 1 element) required multiple iterations and achieved consensus with votes from 8 available panelists. The elements encompassed a range of factors, including drug use and indications, previous exposure and duration of therapy, recent drug exposure and laboratory results and expectations for subsequent administration, therapy goals, patient education and comprehension, and expectations for clinical management. Twelve of the elements are applicable to any anticoagulant, and 3 are specific to warfarin. CONCLUSION The ACDC List identifies specific pieces of clinical information that a panel of anticoagulant experts agree should be communicated to downstream providers for all anticoagulated patients undergoing care transitions. Additional study is needed to objectively evaluate the ability of existing care systems to communicate the elements and to assess possible relationships between communication of the elements and clinical outcomes.
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Metaxas C, Albert V, Stahl M, Hersberger KE, Arnet I. Development and validation of a questionnaire to self-assess patient knowledge of direct oral anticoagulants (KODOA-test). DRUG HEALTHCARE AND PATIENT SAFETY 2018; 10:69-77. [PMID: 30050329 PMCID: PMC6055885 DOI: 10.2147/dhps.s152954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Few studies have examined associations between patient knowledge of direct oral anticoagulants (DOAC) and clinical outcomes, mostly because of the lack of validated questionnaires for assessing knowledge. The aim of this study was to develop and validate a questionnaire to self-assess knowledge of DOAC. Methods Twelve anticoagulation experts participated in the questionnaire development process to ensure content validity. The Knowledge Of Direct Oral Anticoagulants (KODOA)-test was submitted to patients on DOAC and to pharmacists to assess construct validity. Responsiveness was evaluated after educational counseling. Test-retest reliability was assessed to ensure stability over time, and Cronbach's α was calculated for internal reliability. Index of difficulty and item discrimination (D-value) were calculated to assess the performance of single items. Results The KODOA-test contains 15 items with multiple-choice answers. Each correct answer scores 1 point (max. score of 15). The KODOA-test was administered to 32 patients on DOAC and 28 pharmacists. Pharmacists scored significantly higher than patients at baseline (median score 13.3 vs 10.0; p<0.001), supporting construct validity. Patient scores increased significantly after educational counseling (median score 11 [interquartile range 2] vs 14 [interquartile range 3]; p<0.001). Test-retest and Cronbach's α were acceptable with a Pearson's correlation of 0.8 and an α of 0.67. The index of difficulty for most items was satisfactory (0.38-0.72) and the mean D-value was 42.5%. Conclusion The KODOA-test is a brief, valid, and reliable knowledge self-assessment questionnaire that may be used in clinical trials to investigate associations between knowledge increase and patient-related outcomes.
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Affiliation(s)
- Corina Metaxas
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland,
| | - Valerie Albert
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland,
| | - Matthias Stahl
- Department of Internal Medicine, Kantonsspital Basel-Land, Bruderholz, Switzerland
| | - Kurt E Hersberger
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland,
| | - Isabelle Arnet
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland,
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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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Obamiro KO, Chalmers L, Lee K, Bereznicki BJ, Bereznicki LRE. Anticoagulation knowledge in patients with atrial fibrillation: An Australian survey. Int J Clin Pract 2018; 72:e13072. [PMID: 29457323 DOI: 10.1111/ijcp.13072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/18/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia in clinical practice, and is associated with a significant medical and economic burden. Anticoagulants reduce the risk of stroke and systemic embolism by approximately two-thirds compared with no therapy. Knowledge regarding anticoagulant therapy can influence treatment outcomes in patients with AF. OBJECTIVE To measure the level of anticoagulation knowledge in patients with AF taking oral anticoagulants (OACs), investigate the association between patient-related factors and anticoagulation knowledge, and compare these results in patients taking warfarin and direct-acting oral anticoagulant (DOACs). METHODS Participants were recruited for an online survey via Facebook. Survey components included the Anticoagulation Knowledge Tool, the Perception of Anticoagulant Treatment Questionnaires (assessing treatment expectations, convenience and satisfaction), a modified Cancer Information Overload scale and the Morisky Medication Adherence Scale. Treatment groups were compared and predictors of OAC knowledge were identified. RESULTS Participants taking warfarin had a higher knowledge score compared with those taking DOACs (n = 386, 73% ± 13% vs 66% ± 14%, P<.001). Advancing age, type of OAC, health information overload and ease of OAC use (treatment expectation) were significant predictors of knowledge. Treatment expectation, including the belief that OAC treatment would cause bleeding side effects, varied significantly between participants taking warfarin and DOACs (P = .011). CONCLUSION The study identified knowledge gaps in patients taking OACs, and these deficiencies appeared to be greater in participants taking DOACs. Knowledge assessment should be integrated into patient counselling sessions to help identify and resolve knowledge deficits.
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Affiliation(s)
- Kehinde O Obamiro
- Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Leanne Chalmers
- Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Kenneth Lee
- Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia
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15
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Rolls CA, Obamiro KO, Chalmers L, Bereznicki LRE. The relationship between knowledge, health literacy, and adherence among patients taking oral anticoagulants for stroke thromboprophylaxis in atrial fibrillation. Cardiovasc Ther 2017; 35. [PMID: 28869793 DOI: 10.1111/1755-5922.12304] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients' knowledge regarding their oral anticoagulant (OAC) treatment for stroke prevention in atrial fibrillation (AF), their level of medication adherence, and health literacy are known to affect treatment outcomes. However, contemporary data regarding the relationships between these variables are lacking. OBJECTIVE To investigate the relationships between anticoagulant knowledge, health literacy, and self-reported adherence in patients taking warfarin and the directly acting oral anticoagulants. METHODS A cross-sectional survey was conducted in 48 patients with AF identified from general practices. The Anticoagulation Knowledge Tool (AKT) was used to assess anticoagulation knowledge; the Short Test of Functional Health Literacy in Adults (s-TOFHLA) for health literacy; and the 8-item Morisky Medication Adherence Scale (MMAS) for medication adherence. RESULTS Participants had mean scores of 61.6 ± 15.8, 7.2 ± 1.1, and 24.7 ± 9.5 for the AKT, MMAS-8 and s-TOFHLA, respectively. Significant correlations were observed between anticoagulation knowledge and health literacy with medication adherence (0.37, P < .01 and .30, P < .05, respectively). Participants with inadequate health literacy had a significantly lower mean knowledge score than those with adequate health literacy (55.8 ± 15.9 vs 66.1 ± 14.4, P < .05). Participants who self-reported adherence to their OAC had significantly higher knowledge scores than those who did not (67.5 ± 13.3 vs 56.1 ± 16.2, P < .05). CONCLUSION Significant correlations between health literacy, OAC knowledge, and adherence were observed, and these relationships should to be considered by health professionals responsible for monitoring patients who are prescribed anticoagulants. We also observed serious gaps in OAC knowledge. Interventions designed to optimize the outcomes of anticoagulant treatment need to address these factors.
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Affiliation(s)
- Chanelle A Rolls
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Kehinde O Obamiro
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Leanne Chalmers
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Luke R E Bereznicki
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tas, Australia
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16
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Zdyb EG, Courtney DM, Malik S, Schmidt MJ, Lyden AE. Impact of Discharge Anticoagulation Education by Emergency Department Pharmacists at a Tertiary Academic Medical Center. J Emerg Med 2017; 53:896-903. [PMID: 28941557 DOI: 10.1016/j.jemermed.2017.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although pharmacists commonly provide patient education and help manage high-risk anticoagulant medications in inpatient and outpatient settings, the evidence for these interventions in the emergency department (ED) is less established, especially in the era of direct-acting oral anticoagulants. In 2013, a formal program was initiated whereby patients discharged with a new prescription for any anticoagulant receive education from an ED pharmacist when on-site. In addition, they received follow-up phone calls from an ED pharmacist within 72 hours of discharge. OBJECTIVE We sought to identify the impact of pharmacist education, defined as the need for intervention on callback, versus physician and nursing-driven discharge measures on patient understanding and appropriate use of anticoagulant medications. METHODS A single-center retrospective analysis included patients discharged from the ED between May 2013 and May 2016 with a new anticoagulant prescription. Electronic callback records were reviewed to assess patients' adherence and understanding of discharge instructions as well as for an anticoagulant-related hospital readmission within 90 days. RESULTS One hundred seventy-four patients were evaluated in a per protocol analysis. Patients who did not receive pharmacist education prior to discharge required an increased need for intervention during callback versus those who did (36.4% vs. 12.9%, p = 0.0005) related to adherence, inappropriate administration, and continued use of interacting medications or supplements, among other concerns. In addition, patients who had not received pharmacist counseling were more likely to be readmitted to a hospital or return to the ED within 90 days after their initial visit for an anticoagulation-related problem versus patients who had (12.12% vs. 1.85%, p = 0.0069). CONCLUSION Discharge education by ED pharmacists leads to improved patient understanding and appropriate use of anticoagulants.
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Affiliation(s)
- Elizabeth G Zdyb
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois
| | - D Mark Courtney
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjeev Malik
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael J Schmidt
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Abbie E Lyden
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois; College of Pharmacy, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
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Clarkesmith DE, Pattison HM, Khaing PH, Lane DA. Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation. Cochrane Database Syst Rev 2017; 4:CD008600. [PMID: 28378924 PMCID: PMC6478129 DOI: 10.1002/14651858.cd008600.pub3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Current guidelines recommend oral anticoagulation therapy for patients with atrial fibrillation (AF) with one or more risk factors for stroke; however, anticoagulation control (time in therapeutic range (TTR)) with vitamin K antagonists (VKAs) is dependent on many factors. Educational and behavioural interventions may impact patients' ability to maintain their international normalised ratio (INR) control. This is an updated version of the original review first published in 2013. OBJECTIVES To evaluate the effects of educational and behavioural interventions for oral anticoagulation therapy (OAT) on TTR in patients with AF. SEARCH METHODS We updated searches from the previous review by searching the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) in The Cochrane Library (January 2016, Issue 1), MEDLINE Ovid (1949 to February week 1 2016), EMBASE Classic + EMBASE Ovid (1980 to Week 7 2016), PsycINFO Ovid (1806 to Week 1 February 2016) and CINAHL Plus with Full Text EBSCO (1937 to 16/02/2016). We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials evaluating the effect of any educational and behavioural intervention compared with usual care, no intervention, or intervention in combination with other self-management techniques among adults with AF who were eligible for, or currently receiving, OAT. DATA COLLECTION AND ANALYSIS Two of the review authors independently selected studies and extracted data. Risk of bias was assessed using the Cochrane 'Risk of bias' tool. We included outcome data on TTR, decision conflict (patient's uncertainty in making health-related decisions), percentage of INRs in the therapeutic range, major bleeding, stroke and thromboembolic events, patient knowledge, patient satisfaction, quality of life (QoL), beliefs about medication, illness perceptions, and anxiety and depression. We pooled data for three outcomes - TTR, anxiety and depression, and decision conflict - and reported mean differences (MD). Where insufficient data were present to conduct a meta-analysis, we reported effect sizes and confidence intervals (CI) from the included studies. We evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. MAIN RESULTS Eleven trials with a total of 2246 AF patients (ranging from 14 to 712 by study) were included within the review. Studies included education, decision aids, and self-monitoring plus education interventions. The effect of self-monitoring plus education on TTR was uncertain compared with usual care (MD 6.31, 95% CI -5.63 to 18.25, I2 = 0%, 2 trials, 69 participants, very low-quality evidence). We found small but positive effects of education on anxiety (MD -0.62, 95% CI -1.21 to -0.04, I2 = 0%, 2 trials, 587 participants, low-quality evidence) and depression (MD -0.74, 95% CI -1.34 to -0.14, I2 = 0%, 2 trials, 587 participants, low-quality evidence) compared with usual care. The effect of decision aids on decision conflict favoured usual care (MD -0.1, 95% CI -0.17 to -0.02, I2 = 0%, 2 trials, 721 participants, low-quality evidence). AUTHORS' CONCLUSIONS This review demonstrates that there is insufficient evidence to draw definitive conclusions regarding the impact of educational or behavioural interventions on TTR in AF patients receiving OAT. Thus, more trials are needed to examine the impact of interventions on anticoagulation control in AF patients and the mechanisms by which they are successful. It is also important to explore the psychological implications for patients suffering from this long-term chronic condition.
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Affiliation(s)
- Danielle E Clarkesmith
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS TrustDudley RoadBirminghamUKB18 7QH
| | - Helen M Pattison
- Aston UniversitySchool of Life and Health SciencesAston TriangleBirminghamUKB4 7ET
| | - Phyo H Khaing
- University of BirminghamCollege of Medical and Dental Sciences8 Minnesota DriveGreat SankeyBirminghamCheshireUKWA5 3SY
| | - Deirdre A Lane
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS TrustDudley RoadBirminghamUKB18 7QH
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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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Dreijer AR, Kruip MJHA, Diepstraten J, Polinder S, Brouwer R, Leebeek FWG, Vulto AG, van den Bemt PMLA. Antithrombotic stewardship: a multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: a study protocol. BMJ Open 2016; 6:e011537. [PMID: 27998897 PMCID: PMC5223636 DOI: 10.1136/bmjopen-2016-011537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antithrombotic therapy carries high risks for patient safety. Antithrombotics belong to the top 5 medications involved in potentially preventable hospital admissions related to medication. To provide a standard for antithrombotic therapy and stress the importance of providing optimal care to patients on antithrombotic therapy, the Landelijke Standaard Ketenzorg Antistolling (LSKA; Dutch guideline on integrated antithrombotic care) was drafted. However, the mere publication of this guideline does not guarantee its implementation. This may require a multidisciplinary team effort. Therefore, we designed a study aiming to determine the influence of hospital-based antithrombotic stewardship on the effect and safety of antithrombotic therapy outcomes during and after hospitalisation. METHODS AND ANALYSIS In this study, the effect of the implementation of a multidisciplinary antithrombotic team is compared with usual care using a pre-post study design. The study is performed at the Erasmus University Medical Center Rotterdam and the Reinier de Graaf Hospital Delft. Patients who are or will be treated with antithrombotics are included in the study. We aim to include 1900 patients, 950 in each hospital. Primary outcome is the proportion of patients with a composite end point consisting of ≥1 bleeding or ≥1 thrombotic event from the beginning of antithrombotic therapy (or hospitalisation) until 3 months after hospitalisation. Bleeding is defined according to the International Society of Thrombosis and Haemostasis (ISTH) classification. A thrombotic event is defined as any objectively confirmed arterial or venous thrombosis, including acute myocardial infarction or stroke for arterial thrombosis and deep venous thrombosis or pulmonary embolism or venous thrombosis. An economic evaluation is performed to determine whether the implementation of the multidisciplinary antithrombotic team will be cost-effective. ETHICS AND DISSEMINATION This protocol was approved by the Medical Ethical Committee of the Erasmus University Medical Center. The findings of the study will be disseminated through peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER NTR4887; pre-results.
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Affiliation(s)
- Albert R Dreijer
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Hospital Pharmacy, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeroen Diepstraten
- Department of Hospital Pharmacy, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rolf Brouwer
- Department of Hematology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arnold G Vulto
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
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20
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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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Lee JA, Evangelista LS, Moore AA, Juth V, Guo Y, Gago-Masague S, Lem CG, Nguyen M, Khatibi P, Baje M, Amin AN. Feasibility Study of a Mobile Health Intervention for Older Adults on Oral Anticoagulation Therapy. Gerontol Geriatr Med 2016; 2:2333721416672970. [PMID: 28680940 PMCID: PMC5486482 DOI: 10.1177/2333721416672970] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Oral anticoagulation treatment (OAT) such as warfarin therapy is recommended for older adults with atrial fibrillation, heart failure, or who are at risk for venous thromboembolism. Despite its proven benefits, older adults report both dissatisfaction with OAT and reduced quality of life that can potentially lead to low adherence to OAT and decreased treatment efficacy. Objective: To test the feasibility of Mobile Applications for Seniors to enhance Safe anticoagulation therapy (MASS), a mobile-based health technology intervention designed to promote independence and self-care. Methods: This pilot study used a single-arm experimental pre–post design to test the feasibility of a 3-month intervention using MASS in 18 older adults (male: n = 14; White: n = 9; Hispanic: n = 7; Other: n = 2; M age = 67). MASS was available in English or Spanish. Participants completed surveys about their OAT knowledge, attitudes, quality of life with OAT, and adherence at baseline and at a 3-month follow-up. Satisfaction with the MASS intervention was also assessed at follow-up. Results: Anticoagulation knowledge significantly improved from baseline to follow-up (Mbase = 12.5 ± 5.51, Mfollow-up = 14.78 ± 3.93, p = .007). Other outcomes were not different, pre- and post-tests. Participants reported they were generally satisfied with MASS, its ease of use and its usefulness. Conclusion: The results showed use of MASS improved older adults’ knowledge of OAT. Using mHealth apps may enhance self-care among older adults with chronic conditions who are also taking oral anticoagulants.
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Affiliation(s)
- Jung-Ah Lee
- Program in Nursing Science, University of California Irvine, Irvine, CA, USA
- Jung-Ah Lee, Associate Professor, 100A Berk Hall, Program in Nursing Science, University of California, Irvine, Irvine, CA 92697-3959, USA.
| | | | - Alison A. Moore
- Division of Geriatrics, University of California San Diego, San Diego, CA, USA
| | - Vanessa Juth
- Program in Nursing Science, University of California Irvine, Irvine, CA, USA
| | - Yuqing Guo
- Program in Nursing Science, University of California Irvine, Irvine, CA, USA
| | - Sergio Gago-Masague
- California Institute for Telecommunications and Information Technology, University of California Irvine, Irvine, CA, USA
| | - Carolyn G. Lem
- Pharmacy departments, University of California Irvine Medical Center, Orange, CA, USA
| | - Michelle Nguyen
- Pharmacy departments, University of California Irvine Medical Center, Orange, CA, USA
| | - Parmis Khatibi
- Pharmacy departments, University of California Irvine Medical Center, Orange, CA, USA
| | - Mark Baje
- Pharmacy departments, University of California Irvine Medical Center, Orange, CA, USA
| | - Alpesh N. Amin
- Department of Medicine, University of California Irvine, Irvine, CA, USA
- Hospitalist Program, University of California Irvine Medical Center, Orange, CA, USA
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22
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Masnoon N, Sorich W, Alderman CP. A study of consumer retention of key information provided by clinical pharmacists during anticoagulant counselling. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2016. [DOI: 10.1002/jppr.1187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Nashwa Masnoon
- Royal Adelaide Hospital; Adelaide Australia
- University of South Australia; Adelaide Australia
| | | | - Christopher P. Alderman
- University of South Australia; Adelaide Australia
- Teaching; Training and Research; SA Pharmacy; Adelaide Australia
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Rahmani P, Guzman C, Kezouh A, Blostein M, Kahn SR. Association Between Patient Knowledge of Anticoagulation, INR Control, and Warfarin-Related Adverse Events. J Pharm Technol 2016. [DOI: 10.1177/8755122516644622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Whether the level of patient’s knowledge about warfarin plays any role in maintenance of therapeutic international normalized ratio (INR) is controversial. Several studies have looked at patients’ warfarin knowledge and the level of patients’ anticoagulation control (AC). Most studies had small numbers and did not use validated questionnaires. Objectives: To use the Oral Anticoagulation Knowledge (OAK) test to assess patients’ knowledge of AC and to examine associations between knowledge, INR, and adverse events. Methods: In this cross-sectional study, patients were asked to complete the OAK test. Data on clinical and demographic characteristics, INR values, and thrombosis or bleeding events during the preceding 1 year period were collected. Associations between OAK scores, patient characteristics, proportion of therapeutic INRs, and bleeding/thrombosis events were assessed. Results: A total of 225 patients completed the OAK test. Mean (SD) age was 70 (13.4) years, 53% were male, and 75% were on warfarin for >3 years. Over the preceding year, 57.3% of INRs were therapeutic, and there were 22 bleeding and 6 thrombotic events. The mean OAK score was 12/20 (passing score = 15/20); 64% of patients failed the OAK test. Predictors of passing the OAK test were younger age ( P = .01) and higher level of education ( P = .03). There was no association between OAK score and proportion of therapeutic INRs, or OAK score and bleeding or thrombosis events. Conclusion: We used the OAK test to assess patients’ AC knowledge. Results suggests that while younger and more educated patients were more likely to pass the OAK test, the OAK test results may not predict INR control or occurrence of bleeding or thrombotic events.
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Affiliation(s)
- Poupak Rahmani
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Abbas Kezouh
- Jewish General Hospital, Montreal, Quebec, Canada
| | - Mark Blostein
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Susan R. Kahn
- Jewish General Hospital, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Obamiro KO, Chalmers L, Bereznicki LRE. Development and Validation of an Oral Anticoagulation Knowledge Tool (AKT). PLoS One 2016; 11:e0158071. [PMID: 27351746 PMCID: PMC4924828 DOI: 10.1371/journal.pone.0158071] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Assessing and improving patients' anticoagulation knowledge can lead to better treatment outcomes. While validated knowledge instruments exist for use in people taking warfarin, these tools are not necessarily applicable to patients taking direct-acting oral anticoagulants. OBJECTIVE To develop and validate an oral anticoagulation knowledge instrument that is applicable to all oral anticoagulant medications. METHODS Ten anticoagulation experts participated in the development of the Anticoagulation Knowledge Tool to ensure content validity. The knowledge instrument was administered to three groups of participants comprising of 44 pharmacists, 50 patients and 50 members of the general public. A subgroup of participants in the patient and pharmacist group were retested approximately 2-3 months after the initial testing. Statistical tests were conducted to determine the validity and reliability of the scale, and item analysis was used to determine the performance of individual questions. RESULTS The 28-item instrument developed had a scale content validity index of 0.92, supporting content validity. The pharmacist group's mean score was significantly higher than that of the patient group, and the patient group scored significantly higher than the general public group (94% vs 62% vs 20%, respectively; p<0.001), supporting construct validity. Internal consistency reliability was acceptable with a Cronbach's α value of > 0.7 across the three groups, and the test-retest reliability was confirmed with a Pearson's correlation coefficient of 0.72 and 0.78 for the pharmacist and patient groups, respectively. CONCLUSION The Anticoagulation Knowledge Tool is a valid and reliable instrument that can be used in routine clinical practice to assess patients' anticoagulation knowledge.
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Affiliation(s)
| | - Leanne Chalmers
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Australia
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25
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Abstract
OBJECTIVE To evaluate the effectiveness of a warfarin educational video in the hospital setting and to determine patients' satisfaction with using an iPad to view a warfarin educational video. METHODS This prospective quality improvement project included adult (≥18 years of age) patients on warfarin in the hospital. All patients completed pre-video and post-video knowledge tests on the iPad before and after viewing the educational video on warfarin therapy. Patients also completed a patient satisfaction survey. RESULTS Forty hospitalized patients were educated using the warfarin video and included for analysis. The majority of patients were new to warfarin therapy (65%). Forty-three percent of patients passed the pre-video knowledge test, and 90% passed the post-video knowledge test (P < 0.001). No significant differences were observed among knowledge test scores when compared by age, sex, level of education, and use of central nervous system depressant medications. Most patients (82.5%) reported they liked using the iPad and found it easy to use. Patients who were younger (< 65 years) and female subjects reported they liked using the iPad more than older patients (P = 0.01) and male subjects (P = 0.02), respectively. Also, younger patients found the iPad easier to use compared with patients who were older (P = 0.01). CONCLUSION Educating hospitalized patients about warfarin by using a video on an iPad was effective. Video education on an iPad may be an alternative to traditional education in the hospital setting.
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Altiok M, Yilmaz M, Rencüsoğullari I. Living with Atrial Fibrillation: An Analysis of Patients' Perspectives. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:305-11. [PMID: 26724239 DOI: 10.1016/j.anr.2015.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 08/06/2015] [Accepted: 09/02/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this study was to determine the perceptions of patients with atrial fibrillation regarding the disease, to reveal their feelings, thoughts and wishes, and to investigate their perspectives and coping behaviors towards their condition. METHODS Phenomenological methodology was used. The study population consisted of a total of 225 patients treated by the cardiology department of a university hospital, while the study sample consisted of 32 patients who met the inclusion criteria. A semistructured interview addressed perceptions of patients with atrial fibrillation regarding the disease. Data were collected by asking the participants the three questions on the In-depth Individual Interview Form. Data were analyzed using the continuous comparative method of Colaizzi. RESULTS In the study sample, 50.0% of participants were female, 69.0% were married, and the mean age was 66.90 years (± 7.90 years). As a result of the content analysis, four main themes and 15 subthemes were identified: patient's mental status regarding the disease, patient's social status regarding the disease, patient's physical condition regarding the disease, and disease management and coping with the disease. The study found that individuals with atrial fibrillation faced major limitations in their daily living activities and social lives due to the disease symptoms and warfarin use. CONCLUSIONS Patients need to be provided with relevant individual training and counselling so that they lead more satisfactory lives. In addition, appropriate health appointment and monitoring systems should be developed for patients to reduce the problems associated with frequent follow-up appointments.
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Affiliation(s)
- Meral Altiok
- Health High School, Mersin University, Mersin, Turkey.
| | - Mualla Yilmaz
- Health High School, Mersin University, Mersin, Turkey
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Vormfelde SV, Abu Abed M, Hua TD, Schneider S, Friede T, Chenot JF. Educating orally anticoagulated patients in drug safety: a cluster-randomized study in general practice. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:607-14. [PMID: 25283757 DOI: 10.3238/arztebl.2014.0607] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/18/2014] [Accepted: 06/18/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Orally anticoagulated patients with insufficient knowledge about their treatment have a higher risk of complications. Standardized patient education could raise their level of knowledge and improve time spent within target INR range. METHODS This cluster randomized trial included 319 anticoagulated patients drawn from 22 general medical practices. 185 patients received patient education, conducted by practice nurses, consisting of a video, a brochure, and a questionnaire; 134 control patients received only the brochure. The primary endpoint was knowledge about treatment six months after the patient education session. The secondary endpoints were time in the INR (international normalized ratio) target range and complications of anticoagulation. RESULTS Patients in the intervention and control groups were of comparable mean age (73 vs. 72 years). They answered a comparable number of questions correctly before the intervention (6.8 ± 0.2 vs. 6.7 ± 0.2) but differed significantly on this measure at six months (9.9 ± 0.2 vs. 7.6 ± 0.2, mean difference 2.3 questions, 95% confidence interval [CI] 1.5-3.1, p< 0.001). In the six months prior to the intervention, the INR was in the target range 65 ± 2% vs. 66 ± 3% of the time; in the six months afterward, 71 ± 1% vs. 64 ± 3% of the time (mean difference 7 percentage points, 95% CI -2 to -16 percentage points, p = 0.11). The complication rates were comparable in the two groups (12% vs. 16%, p = 0.30). Patients in the intervention group approved of patient education sessions to a greater extent than control patients (87% vs. 56%). CONCLUSION Patient education was found to be practical, to improve knowledge relating to patient safety in a durable manner, and to meet with the approval of the patients who received it. There was a statistically non-significant trend toward an improvement of the time spent in the INR target range. In view of the major knowledge deficits of orally anticoagulated patients, standardized patient education ought to be made a part of their routine care.
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Affiliation(s)
- Stefan Viktor Vormfelde
- Department of Clinical Pharmacology, University Medical Center Göttingen, Department of General Practice, University Medical Center Göttingen, Department of Medical Statistics University Medical Center Göttingen, Institute for Community Medicine, Section General Practice and Family Medicine, University of Greifswald
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Baysari MT, Welch S, Richardson K, Sharratt G, Clough J, Heywood M, Melocco T, Harvey PA, Jennings R, Carter L, Elliott RA, Shankar PR, Hoenemann D, Wan V, Luetsch K, Burrows J, Lui V. Letters to the Editor. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2012.tb00178.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)
- Melissa T Baysari
- Australian Institute of Health Innovation, Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital; University of New South Wales; Darlinghurst NSW 2010
| | - Susan Welch
- St Vincent's Hospital; The University of Sydney
| | | | | | | | | | | | | | | | | | - Rohan A Elliott
- Centre for Medicine Use and Safety; Monash University, Austin Health; Heidelberg Vic. 3084
| | - P Ravi Shankar
- Department of Clinical Pharmacology and Therapeutics; KIST Medical College; Lalitpur Nepal
| | | | - Verna Wan
- Department of Health; Melbourne Vic. 3000
| | | | - Judy Burrows
- School of Pharmacy, Pharmacy Australia Centre of Excellence; The University of Queensland; Woolloongabba Qld 4102
| | - Viki Lui
- Royal Park Campus; Royal Melbourne Hospital; Parkville Vic. 3052
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Moore SJ, Blair EA, Steeb DR, Reed BN, Hull JH, Rodgers JE. Impact of Video Technology on Efficiency of Pharmacist-Provided Anticoagulation Counseling and Patient Comprehension. Ann Pharmacother 2015; 49:631-8. [DOI: 10.1177/1060028015575352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Discharge anticoagulation counseling is important for ensuring patient comprehension and optimizing clinical outcomes. As pharmacy resources become increasingly limited, the impact of informational videos on the counseling process becomes more relevant. Objective: To evaluate differences in pharmacist time spent counseling and patient comprehension (measured by the Oral Anticoagulation Knowledge [OAK] test) between informational videos and traditional face-to-face (oral) counseling. Methods: This prospective, open, parallel-group study at an academic medical center randomized 40 individuals—17 warfarin-naïve (“New Start”) and 23 with prior warfarin use (“Restart”)—to receive warfarin discharge education by video or face-to-face counseling. “Teach-back” questions were used in both groups. Results: Although overall pharmacist time was reduced in the video counseling group ( P < 0.001), an interaction between prior warfarin use and counseling method ( P = 0.012) suggests the difference between counseling methods was smaller in New Start participants. Following adjustment, mean total time was reduced 8.71 (95% CI = 5.15-12.26) minutes (adjusted P < 0.001) in Restart participants and 2.31 (−2.19 to 6.81) minutes (adjusted P = 0.472) in New Start participants receiving video counseling. Postcounseling OAK test scores did not differ. Age, gender, socioeconomic status, and years of education were not predictive of total time or OAK test score. Conclusion: Use of informational videos coupled with teach-back questions significantly reduced pharmacist time spent on anticoagulation counseling without compromising short-term patient comprehension, primarily in patients with prior warfarin use. Study results demonstrate that video technology provides an efficient method of anticoagulation counseling while achieving similar comprehension.
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Affiliation(s)
| | | | | | - Brent N. Reed
- University of Maryland School of Pharmacy, Baltimore, MD, USA
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30
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Shaha M, Wüthrich E, Stauffer Y, Herczeg F, Fattinger K, Hirter K, Papalini M, Herrmann L. Implementing evidence-based patient and family education on oral anticoagulation therapy: a community-based participatory project. J Clin Nurs 2015; 24:1534-45. [PMID: 25763658 DOI: 10.1111/jocn.12743] [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] [Accepted: 03/15/2014] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This study aimed at developing and implementing evidence-based patient and family education on oral anticoagulation therapy. BACKGROUND The number of persons with chronic diseases who live at home is increasing. They have to manage multiple diseases and complex treatments. One such treatment is oral anticoagulation therapy, a high risk variable dose medication. Adherence to oral anticoagulation therapy is jeopardised by limited information about the medications, their risk and complications, the impact of individual daily routine and the limited inclusion of family members in education. Hence, improved and tailored education is essential for patients and families to manage oral anticoagulation therapy at home. DESIGN AND METHODS A community-based participatory research design combined with the Precede-Proceed model was used including a systematic literature review, posteducation analysis, an online nurse survey, a documentation analysis and patient/family interviews. The study was conducted between April 2010-December 2012 at a department of general internal medicine in a teaching hospital in Switzerland. Participants were the department's nursing and medical professionals including the patients and their families. RESULTS The evidence-based patient and family education on oral anticoagulation therapy emerged comprising a learning assessment, teaching units, clarification of responsibilities of nurse professionals and documentation guidelines. CONCLUSION AND CLINICAL RELEVANCE The inclusion of the whole department has contributed to the development and implementation of this evidence-based patient family education on oral anticoagulation therapy, which encompasses local characteristics and patient preferences. This education is now being used throughout the department.
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Affiliation(s)
- Maya Shaha
- Institute of Nursing Education and Research, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Nursing Development, Directorate of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital Bern University Hospital, Bern, Switzerland
| | - Erika Wüthrich
- Department of Nursing Development, Directorate of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital Bern University Hospital, Bern, Switzerland.,University Clinic of General Internal Medicine, Inselspital Bern University Hospital, Bern, Switzerland
| | - Yvonne Stauffer
- Department of Nursing, Quality and Development, University Clinic of General Internal Medicine, Inselspital Bern University Hospital, Bern, Switzerland
| | - Franziska Herczeg
- University Clinic of General Internal Medicine, Inselspital Bern University Hospital, Bern, Switzerland
| | - Karin Fattinger
- Department of Medicine and Rehabilitation, Hospital of Schaffhausen, Schaffhausen, Switzerland
| | - Kathrin Hirter
- Department of Nursing Development, Directorate of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital Bern University Hospital, Bern, Switzerland
| | - Marianne Papalini
- University Clinic of General Internal Medicine, Inselspital Bern University Hospital, Bern, Switzerland
| | - Luzia Herrmann
- Department of Nursing Development, Directorate of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital Bern University Hospital, Bern, Switzerland
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Barajas MR, Formea CM, McCormick JB, Abdalrhim AD, Han LC, McBane RD, Fiksdal AS, Kullo IJ. A patient-centered approach to the development and pilot of a warfarin pharmacogenomics patient education tool for health professionals. CURRENTS IN PHARMACY TEACHING & LEARNING 2015; 7:249-255. [PMID: 25729462 PMCID: PMC4339072 DOI: 10.1016/j.cptl.2014.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe an exploratory project to develop and pilot a novel patient educational tool that explains the concept of pharmacogenomics and its impact on warfarin dosing that can be utilized by health professionals providing patient counseling. METHODS A pharmacogenomics educational tool prototype was developed by an interdisciplinary team. During the pilot of the tool, focus group methodology was used to elicit input from patients based upon their perspectives and experiences with warfarin. Focus group sessions were audio-recorded and transcribed, and the data was analyzed through consensus coding in NVivo. RESULTS The focus group participants were generally unfamiliar with the concept of pharmacogenomics but were receptive to the information. They thought the patient education tool was informative and would provide the most benefit to patients newly initiated on warfarin therapy. CONCLUSIONS Preliminary results from this exploratory project suggest that implementation and further feasibility testing of this pharmacogenomics patient education tool should be performed in a population of newly initiated patients taking warfarin.
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Affiliation(s)
- Megan R Barajas
- Hospital Pharmacy Services, Mayo Clinic Hospital-St. Marys Campus, 200 First Street SW, Rochester, MN 55905,
| | - Christine M Formea
- Hospital Pharmacy Services, Mayo Clinic Hospital-St. Marys Campus, 200 First Street SW, Rochester, MN 55905, 1-507-255-7552,
| | - Jennifer B McCormick
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Ahmed D Abdalrhim
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Leona C Han
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Robert D McBane
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Alexander S Fiksdal
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Iftikhar J Kullo
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
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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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Chenot JF, Hua TD, Abu Abed M, Schneider-Rudt H, Friede T, Schneider S, Vormfelde SV. Safety relevant knowledge of orally anticoagulated patients without self-monitoring: a baseline survey in primary care. BMC FAMILY PRACTICE 2014; 15:104. [PMID: 24885192 PMCID: PMC4045910 DOI: 10.1186/1471-2296-15-104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/20/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Effective and safe management of oral anticoagulant treatment (OAT) requires a high level of patient knowledge and adherence. The aim of this study was to assess patient knowledge about OAT and factors associated with patient knowledge. METHODS This is a baseline survey of a cluster-randomized controlled trial in 22 general practices with an educational intervention for patients or their caregivers. We assessed knowledge about general information on OAT and key facts regarding nutrition, drug-interactions and other safety precautions of 345 patients at baseline. RESULTS Participants rated their knowledge about OAT as excellent to good (56%), moderate (36%) or poor (8%). However, there was a discrepancy between self-rated knowledge and evaluated actual knowledge and we observed serious knowledge gaps. Half of the participants (49%) were unaware of dietary recommendations. The majority (80%) did not know which non-prescription analgesic is the safest and 73% indicated they would not inform pharmacists about OAT. Many participants (35-75%) would not recognize important emergency situations. After adjustment in a multivariate analysis, older age and less than 10 years education remained significantly associated with lower overall score, but not with self-rated knowledge. CONCLUSIONS Patients have relevant knowledge gaps, potentially affecting safe and effective OAT. There is a need to assess patient knowledge and for structured education programs. TRIAL REGISTRATION Deutsches Register Klinischer Studien (German Clinical Trials Register): DRKS00000586.Universal Trial Number (UTN U1111-1118-3464).
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Affiliation(s)
- Jean-François Chenot
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
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Lakshmi R, James E, Kirthivasan R. Study on Impact of Clinical Pharmacist's Interventions in the Optimal Use of Oral Anticoagulants in Stroke Patients. Indian J Pharm Sci 2013; 75:53-9. [PMID: 23901161 PMCID: PMC3719150 DOI: 10.4103/0250-474x.113550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 01/16/2013] [Accepted: 01/20/2013] [Indexed: 11/04/2022] Open
Abstract
Anticoagulants are very useful medications but can also lead to haemorrhagic as well as thromboembolic complications when not used correctly or without proper medical attention. Anticoagulant's complex pharmacology and pharmacokinetics contribute to its narrow margin of safety. Pharmacist's unique knowledge of pharmacology, pharmacokinetics and interactions makes them well-suited to assist patients in maintaining safe and effective anticoagulation. Successful anticoagulation therapy implies fewer incidences of therapeutic failures and bleeding complications. The anticoagulation management service staffed by clinical pharmacists is a service established to monitor and manage oral and parenteral anticoagulants. In this research work, 40 patients each were included in the intervention and the control groups. In the intervention group, patient's knowledge score on anticoagulation increased from an average of 5.6±3.2 to 13.8±0.94 (P=0.000) after clinical pharmacist's counselling, whereas in the control group there was no significant improvement in patient's baseline knowledge over the knowledge score at the end of the study (8.0±1.59 vs. 8.3±2.6) (P=0.218). In the intervention group, 73.45% of the international normalised ratio test results were within the therapeutic range, 8.45% supratherapeutic and 18.5% subtherapeutic during the 6 months data collection period. The corresponding data for the control group were 53.2 (P=0.000), 18.4 (P=0.000) and 28.4% (P=0.002), respectively. Forty four adverse drug reactions (ADRs) related to anticoagulants were identified in the intervention group as compared to 56 in the control group. These results revealed that the clinical pharmacist's involvement in the anticoagulation management improved the therapeutic outcome of patients and demonstrate the benefits of clinical pharmacist guided anticoagulation clinics in India.
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Affiliation(s)
- R Lakshmi
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham University, AIMS Health Sciences Campus, Kochi-682 041, India
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Clarkesmith DE, Pattison HM, Lane DA. Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation. Cochrane Database Syst Rev 2013:CD008600. [PMID: 23736948 DOI: 10.1002/14651858.cd008600.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Current guidelines recommend oral anticoagulation therapy for patients with atrial fibrillation who are at moderate-to-high risk of stroke, however anticoagulation control (time in therapeutic range (TTR)) is dependent on many factors. Educational and behavioural interventions may impact on patients' ability to maintain their International Normalised Ratio (INR) control. OBJECTIVES To evaluate the effects on TTR of educational and behavioural interventions for oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) in The Cochrane Library (2012, Issue 7 of 12), MEDLINE Ovid (1950 to week 4 July 2012), EMBASE Classic + EMBASE Ovid (1947 to Week 31 2012), PsycINFO Ovid (1806 to 2012 week 5 July) on 8 August 2012 and CINAHL Plus with Full Text EBSCO (to August 2012) on 9 August 2012. We applied no language restrictions. SELECTION CRITERIA The primary outcome analysed was TTR. Secondary outcomes included decision conflict (patient's uncertainty in making health-related decisions), percentage of INRs in the therapeutic range, major bleeding, stroke and thromboembolic events, patient knowledge, patient satisfaction, quality of life (QoL), and anxiety. DATA COLLECTION AND ANALYSIS The two review authors independently extracted data. Where insufficient data were present to conduct a meta-analysis, effect sizes and confidence intervals (CIs) of the included studies were reported. Data were pooled for two outcomes, TTR and decision conflict. MAIN RESULTS Eight trials with a total of 1215 AF patients (number of AF participants included in the individual trials ranging from 14 to 434) were included within the review. Studies included education, decision aids, and self-monitoring plus education.For the primary outcome of TTR, data for the AF participants in two self-monitoring plus education trials were pooled and did not favour self-monitoring plus education or usual care in improving TTR, with a mean difference of 6.31 (95% CI -5.63 to 18.25). For the secondary outcome of decision conflict, data from two decision aid trials favoured usual care over the decision aid in terms of reducing decision conflict, with a mean difference of -0.1 (95% CI -0.2 to -0.02). AUTHORS' CONCLUSIONS This review demonstrated that there is insufficient evidence to draw definitive conclusions regarding the impact of educational or behavioural interventions on TTR in AF patients receiving OAT. Thus, more trials are needed to examine the impact of interventions on anticoagulation control in AF patients and the mechanisms by which they are successful. It is also important to explore the psychological implications for patients suffering from this long-term chronic condition.
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Affiliation(s)
- Danielle E Clarkesmith
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK. 2School of Life and Health Sciences,Aston University, Birmingham, UK
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Stafford L, van Tienen EC, Bereznicki LRE, Peterson GM. The benefits of pharmacist-delivered warfarin education in the home. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2012; 20:384-9. [DOI: 10.1111/j.2042-7174.2012.00217.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 03/27/2012] [Indexed: 11/27/2022]
Abstract
Abstract
Objectives
Good warfarin knowledge is important for optimal patient outcomes, but barriers exist to effective education and warfarin knowledge is often poor. This study aimed to explore the educational outcomes of home-based warfarin education provided by trained pharmacists.
Methods
In a prospective, non-randomised, controlled cohort trial, patients received either usual community-based post-discharge care or a post-discharge warfarin management service, including warfarin education by trained pharmacists during two or three home visits. Patients’ warfarin knowledge was assessed at 8 and 90 days post-discharge using the Oral Anticoagulation Knowledge test.
Key findings
One hundred and thirty-nine patients were recruited into the usual care group between November 2008 and August 2009, and 129 into the intervention group between May and December 2009. Pharmacist-delivered warfarin education was associated with a significant difference between the intervention patients’ baseline and day 8 mean warfarin knowledge scores of 64.5% (95% confidence interval (CI) 61.0–68.5%) and 78.0% (95% CI 74.5–81.5%; P < 0.001), respectively. The intervention patients also scored significantly higher than the usual care patients at day 8 (65.0%, 95% CI 61.5–68.0%; P < 0.001), but not at day 90.
Conclusions
Use of an existing healthcare framework overcame several systemic barriers by facilitating warfarin education in patients’ homes. While the intervention was associated with better short-term warfarin knowledge, follow-up may be required to optimise its benefits. Widespread implementation of home-based warfarin education by pharmacists has the potential to contribute significantly to improved outcomes from warfarin therapy.
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Affiliation(s)
- Leanne Stafford
- Unit for Medication Outcomes Research and Education (UMORE), University of Tasmania, Hobart, Tasmania, Australia
| | - Ella C van Tienen
- Unit for Medication Outcomes Research and Education (UMORE), University of Tasmania, Hobart, Tasmania, Australia
| | - Luke R E Bereznicki
- Unit for Medication Outcomes Research and Education (UMORE), University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M Peterson
- Unit for Medication Outcomes Research and Education (UMORE), University of Tasmania, Hobart, Tasmania, Australia
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Gulseth MP, Wittkowsky AK, Fanikos J, Spinler SA, Dager WE, Nutescu EA. Dabigatran Etexilate in Clinical Practice: Confronting Challenges to Improve Safety and Effectiveness. Pharmacotherapy 2011; 31:1232-49. [DOI: 10.1592/phco.31.12.1232] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nasser S, Mullan J, Bajorek B. Challenges of Older Patients’ Knowledge About Warfarin Therapy. J Prim Care Community Health 2011; 3:65-74. [DOI: 10.1177/2150131911416365] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To review the challenges of warfarin education for older patients (aged 65 years or older) in terms of knowledge, access to warfarin education, and education resources. Methods: A quasi-systematic review of the literature was performed via electronic database searches (eg, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Meditext, and Google Scholar) from 1990 to May 2011. Results: The 62 articles reviewed found that improved patient knowledge results in better anticoagulation control. The review also found that between 50% and 80% of older patients have inadequate knowledge about the basic aspects of warfarin therapy (eg, action, benefits and risks, interactions with other drugs or foods, international normalized ratio management). Demographic factors, such as advancing age, lower family income, and limited health literacy, were found to inversely affect patients’ warfarin knowledge, and access to warfarin education and information resources were often suboptimal in different practice settings. Finally, a number of educational strategies and resources that could be readily incorporated to improve the effectiveness of current warfarin education programs were extracted from the review. Conclusion: This comprehensive review highlights that education about warfarin in older patients is currently suboptimal and may in part contribute to poor therapeutic outcomes. This review article also acknowledges the need to identify, target, and develop educational strategies and resources to further improve older patients’ knowledge about their warfarin therapy.
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