Nível de informação e adesão à terapia de anticoagulação oral com varfarina em pacientes acompanhados em ambulatório de atenção primária à saúde

Abstract

Background: Oral anticoagulation therapy with warfarin is widely used around the world and its safety and efficacy are well-established. Nevertheless, anticoagulants are among the drug classes most associated with fatal medication errors in primary health care. Objective: To investigate patient knowledge, the level of information provided, and medication adherence in patients treated with warfarin at a primary health care service. Method: A cross-sectional study of a prospective cohort of 60 patients on warfarin treatment in the town of Ijuí, Rio Grande do Sul, Brazil. A questionnaire was administered to test patients' knowledge about their prescriptions and the level of information provided by the health team. The 8-item Morisky Medication Adherence Scale (MMAS-8) and International Normalized Ratio (INR) were used to verify adherence to treatment. Results: The results were expressed in absolute and relative values and prevalence ratios were calculated, with respective 95% confidence intervals. It was found that 83.3% of the participants had been given insufficient information by the health team, 50% did not know how to use the medication correctly, 86.7% were not adherent to the treatment according to MMAS-8 and 63.3% were outside of the correct INR range. Conclusion: In this study, we observed a need to improve the quality of information provided to users and to develop strategies to improve adherence to treatment, to ensure the safety of patients treated with warfarin in primary health care services.

Assessment of the warfarin anticoagulation knowledge of patients with mechanical mitral valve prosthesis and its effect on therapy adherence and relevant complications

“…among the patients, 65.5% knew the rationale of warfarin use. Compared with lower rates in other studies [4,14], this result suggests sufficient and informative relevant medical education provided to our patients. The majority (69.6%), which is higher than reported rates of 18% [24], 29.7% [14], 42.8 [22] and 42% [18], were aware of the risks of incorrect warfarin dosage, suggesting that our patients had a good level of knowledge about the relevant risks of incorrect warfarin dosage.…”

“…among these factors, patient education is considered a key factor for safe and optimal anticoagulation therapy [8,9,14]. literature is rich with research on the adherence, satisfaction and outcome of patients on anticoagulation therapy [4,9]. most investigations have been performed on a range of patients on anticoagulants but have not focused on the mechanical heart valve [15].…”

“…Warfarin is a widely used vitamin k antagonist, with a narrow therapeutic index, extensive dosage variability and major side effects. Whereas dosage insufficiency restricts its action on thromboprophylaxis, overdosage can lead to life-threatening bleeding [4]. The interactions of warfarin with certain foods, drugs and supplements can cause improper dosage [5].…”

Avaliação do nível de conhecimento das prescrições na Atenção Primária à Saúde

“…Quanto ao conhecimento do tempo necessário para o tratamento, o valor sofre uma queda comparado com as variáveis anteriormente expostas, pois um pouco mais da metade, 56,10% (n=118), sabem o período da terapia medicamentosa que, na maioria das vezes, é interrompido após o desaparecimento dos sinais e sintomas da doença fazendo com que haja uma diminuição da eficácia ou ineficiência do tratamento resultando no reaparecimento da doença (Souza et al, 2018). Segundo Zanetti (2016), praticamente metade dos participantes pesquisados em seu estudo admitiram desconhecer a resposta ou erraram ao serem questionados quanto ao tempo do tratamento prescrito, valor equivalente ao obtido nesta pesquisa, onde 43,81% (n=92) responderam que não sabiam o tempo da sua terapia medicamentosa, fato semelhante ocorreu quando perguntados sobre o nome do medicamento, como exposto anteriormente (Figura 2).…”

Avaliação Do Conhecimento Sobre a Terapêutica Medicamentosa De Indivíduos Em Uso De Anticoagulantes Orais

“…(10,11) Estudos indicam uma carência de informações prestadas pela equipe de saúde aos pacientes em uso de anticoagulantes, sendo o conhecimento desses indivíduos um fator de suma importância na segurança da terapia, podendo proporcionar melhor adesão no uso dos ACO, melhor controle dos níveis de coagulação e redução de complicações. (11,12) Portanto diante do exposto e da necessidade observada na prática clínica, este estudo tem como objetivo avaliar o conhecimento sobre a terapêutica medicamentosa de indivíduos em uso de anticoagulantes orais.…”