A study of consumer retention of key information provided by clinical pharmacists during anticoagulant counselling

Abstract

Background Patient education delivered through pharmacist counselling is important in promoting the safe and effective use of anticoagulants. Aim To evaluate the extent to which patients retain information after counselling from a clinical pharmacist about the anticoagulant warfarin; to perform a brief analysis of the cost‐analysis of warfarin counselling; and to investigate relationships between case‐specific characteristics and patient outcomes. Method A total of 22 patients was recruited. Eligibility criteria included age ≥18 years, new initiation of warfarin in hospital, intact cognition and an expectation of self‐administration of warfarin after discharge. Key elements of knowledge were assessed immediately after counselling and 6 weeks after counselling. The duration of each counselling session was recorded as a surrogate for costs involved, and case‐specific characteristics were documented. Results Participants demonstrated an ability to recall an average (mean ± standard deviation) of 79.9 ± 14.6% of key information elements immediately after counselling, significantly higher than was observed 6 weeks after counselling (71.0 ± 11.7%; p = 0.02). The percentage of participants achieving an ‘acceptable’ score for knowledge was 68.2%, both immediately after counselling and 6 weeks later. No significant relationships between specific case characteristics and patient outcomes, duration of counselling or overall warfarin knowledge retention scores 6 weeks after counselling were demonstrable. Conclusion These findings imply that more emphasis should be placed on educating patients on the critical information elements for warfarin counselling. Further research is required to explore potential relationships between case‐specific characteristics and patient outcomes, as well as the costs associated with the counselling process.

Patient-focused interventions to support vulnerable people using oral anticoagulants: a narrative review

“…Another finding of our review was the beneficial role of multidisciplinary teams and allied health professionals in supporting older persons across different healthcare settings and during the transition of care between settings. Examples include pharmacist-led INR monitoring in collaboration with general practitioners, 44,45 post-discharge warfarin services, and pharmacist-led education 69 during the transition of care from the hospital to the home setting. The advantage of using pharmacists for INR monitoring and patient education is that they are conveniently located in a variety of healthcare settings such as the community, hospital, and home, and during transitions of care, which can optimize patient safety.…”

“…One study highlighted the importance of pharmacists educating patients about the critical information for warfarin counselling and the need for regular counseling sessions. 69 One limitation of this study was its small sample size ( n = 22).…”

“…Most interventions were effective in improving knowledge. These interventions included DAs, 58–63 written information, 67,68 a program, 73 a video, 64 patient education by a pharmacist, 46,69 and a mobile health application. 75 Several DAs significantly improved knowledge about warfarin.…”

“…The main topics for patient education included the indications and duration of warfarin use, dosing, administration time and actions in the event of missed doses, target INR range, side effects, interactions with other drugs and herbs, and lifestyle issues such as alcohol and diet. Knowledge improved in several areas, such as the purpose of the medication and the identification of adverse effects, 64,67,69 patients’ understanding of when to seek emergency attention, 64 management of missed doses, 64,67 and target INR range. 67 The instruments used for some studies 28,46,65,69 included the Oral Anticoagulation Knowledge test, 76 the Anticoagulation Knowledge Assessment tool, 77 and a tool described by Taylor et al 78…”

Health literacy and knowledge in a cohort of Australian patients taking warfarin

“…In addition, health outcomes of health literacy, knowledge and health impact of self-managed patients versus carer-managed patients taking oral anticoagulants could be explored. Furthermore, although there have been some studies involving pharmacist education to older persons 40 , 42 , 53 and those with limited literacy 40 , there is a need for pharmacists to develop interventions to support CALD patients about warfarin. Several studies in the literature have highlighted the need for medicines information among CALD patients.…”