Adherence in outpatients taking warfarin and its effect on anticoagulation control in Jordan

Abstract

Background Medication adherence is an important element for the success of any therapeutic plan. The picture is more complicated with warfarin, due to its small therapeutic window and patients' needs to have effective anticoagulation control. Objective To measure warfarin-adherence, warfarin-knowledge and to assess the relationship between adherence and anticoagulation control. Setting Adult outpatients (≥18 years) taking warfarin at two medical sites in north of Jordan were invited to participate. Method This was a cross sectional study in which survey questionnaire that included demographic, clinical, warfarin related questions and Morisky Medication Adherence Scale (MMAS-8) was administered to patients in Arabic language. International normalization ratio (INR) readings were retrieved from patients' medical records. Main outcome measure MMAS-8 adherence scores and time within therapeutic range were calculated. Results More than half of study participants (54 %) were adherent (MMAS-8 = 8). The MMAS-8 adherence scores were significantly associated with warfarin-knowledge scores (Spearman's ρ = 0.291, p = 0.000). Adherent patients were more likely to have good anticoagulation control compared to non-adherent patients (MMAS-8 ≤ 7). Conclusion Adherence to warfarin therapy can have a substantial effect on anticoagulation control. Thus, healthcare practitioners should consider strategies to improve patient adherence to warfarin.

Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China

“…In the present study, we also examined the relationships between warfarin adherence and WRKT and BMQ scores. Our findings demonstrated that the proportion of patients being adherent based on their scores in the questionnaires was 67.7%, relatively higher than that reported previously in a Jordanian survey 21 which showed an adherence rate of 46%. A study performed in Singapore using MMAS-8 to examine warfarin adherence reported a high adherence rate of 34.5% (score =8).…”

Association between Patients’ Knowledge and Adherence to Anticoagulants, and Its Effect on Coagulation Control

“…Conversely, Kim et al [38] found that only 27% of patients were adherent to treatment and had INR control although they did not use the MMAS-8 to assess warfarin adherence. However, in another study that was conducted in Jordan by Ababneh et al [64], 25 subjects (10.6%) were adherent to warfarin anticoagulation and had good anticoagulation control, using TTR >70/MMAS score of 8 as the adherence parameter, which is lower than in our study.…”

Association between satisfaction with and adherence to warfarin therapy on the control of international normalized ratio: A hospital-based study in Saudi Arabia

“…Comparatively, other researchers have reported a higher percentage (57.8%) using the same scale (Naderiravesh et al, 2015). Previous research strongly links adherence with the patient’s warfarin knowledge (Ababneh et al, 2016). Providing educational interventions focused on the need to commit to warfarin therapy and reducing patient concerns about the side effects can significantly improve patient adherence (Clarkesmith et al, 2013).…”