Assessment and evaluation efficacy of a clinical pharmacist-led inpatient warfarin knowledge education program and follow-up at a Chinese tertiary referral teaching hospital

Abstract

Background: Oral anticoagulation therapy with warfarin is used to prevent and to treat venous and arterial thrombosis and embolism. Its narrow therapeutic index should be monitored carefully in order to reach the desired outcomes. Objective: This study aims to evaluate the clinical pharmacist-led in-patient warfarin's knowledge education program and to assess a follow-up efficacy in a Chinese tertiary referral teaching hospital. Design and Setting: A cross-sectional and observational study was conducted at the Affiliated Hospital of Medical College of Nanjing University, a 1460-bed tertiary referral teaching hospital in Nanjing. Materials and Methods:One-on-one interview questionnaire was conducted among 47 Chinese patients who had undergone prosthetic valve replacement. Before the patient education program's implemented, at discharge time and 3 months, 6-9 months and 12 months after surgery were considered as time points. A previously validated 17-item questionnaire was used to measure the patient's knowledge level of warfarin and to assess and evaluate a follow-up efficacy of this patient education program run by a clinical pharmacist. Knowledge scores were compared using the Student's t-test or one-way analysis of variance. Main Outcome Measure: Patients' knowledge on the warfarin education program and warfarin knowledge score, drug therapy problems or bleeding complication events associated to warfarin therapy and evaluation of clinical pharmacist's service provided. Results: Patients mean age was 47.68 ± 9.70 years (range 23-67). The higher education strata had significantly higher warfarin knowledge scores (P < 0.05). In terms of hospital stay post-surgery, compared with other groups, patients with an average of 11-14 days, were found significantly and statically higher knowledgeable in warfarin (P < 0.05). The clinical pharmacist' service was found very satisfying f(80.85%). Conclusion: Chinese patients on warfarin therapy should benefit from periodic educational efforts reinforcing key medication safety information. Patient education is not a once-off procedure.A complete patient education program run by a clinical pharmacist in a Cardio-thoracic ward can considerably improve and enhance to reduce the hospital stays and significantly enlighten the role of the patient education in adherence to therapy.

Construção e validação psicométrica de um instrumento para avaliação do conhecimento sobre anticoagulação oral

“…Ao investigar quais eram os determinantes na adesão à terapia com anticoagulantes, Arnsten (1997) identificou que a falta de conhecimento do paciente sobre aspectos importantes da terapia consiste em fator determinante para a não adesão ao tratamento. A compreensão de fatores relacionados à TAO relaciona-se ao sucesso do tratamento, possibilitando maior adesão e, como resultado, o alcance e manutenção de níveis ideais de anticoagulação (BOUNDA et al, 2013;KAKKAR, 2004;NEWALL, 2006).…”

“…As questões abrangiam aspectos gerais sobre o tratamento e eram comumente dispostas em instrumentos autoaplicáveis ou em roteiros usados nas entrevistas (CHENOT et al, 2014;DAVIS et al, 2005;ESMERIO et al, 2009;HENN et al, 2008;JANOLY-DUMÉNIL et al, 2011;JENZARLI et al, 2013;JOSHUA e KAKKAR, 2015;JURCUT et al, 2015;MAYET, 2015;MAVRI et al, 2015;LANE et al, 2006;PERNOD et al, 2008;TANG et al, 2003;TAYLOR et al, 1994;THOMSON et al, 2007;VOMRMFELD et al, 2014). Outros autores utilizaram instrumentos que foram submetidos a uma ou mais etapas do processo de validação segundo a Teoria Clássica dos Testes (TCT) (ALPHONSA et al, 2015;BAKER et al, 2011;BOUNDA et al, 2013;ELBUR et al, 2015;HU et al, 2006;JENZARLI et al, 2013;MATALQAH et al, 2013;OBAMIRO et al, 2016;PRAXEDES et al, 2016;ROCHA et al, 2010;STAFFORD et al, 2012;VAN DAMME et al, 2011).…”

“…A caracterização sociodemográfica se assemelhou a de outros estudos com relação à idade (BRIGGS et al, 2005;PRAXEDES et al, 2016;MATALQAH et al, 2013;ZEOLLA et al, 2006;TANG et al, 2003;JURCUT et al, 2015;VAN DAME et al, 2010;MAYET, 2015;ESMÉRIO et al, 2009;JANOLY-DUMÉNIL et al, 2011;CARVALHO et al, 2013;LEIRIA et al, 2010;PLATT et al, 2010;PRINS et al, 2009;MENENDEZ-JANDULA et al, 2005;HENN et al, 2008;ÁVILA et al, 2011;HU et al, 2006;WINANS et al, 2010) e proporcional ao número de homens e mulheres (TANG et al, 2003;JURCUT et al, 2015;VORMFELD, et al, 2014;CAMPOS et al, 2010;JENZARLI et al, 2013;LEIRIA et al, 2010;MANSUR et al, 2012;PRINS et al, 2009;HENN et al, 2008;ZEOLLA et al, 2006). Em relação à baixa escolaridade dos participantes nossos resultados se assemelharam a outros estudos conduzidos no Brasil (ÁVILA et al, 2011;CARVALHO et al, 2013;ESMÉRIO et al, 2009;HENN et al, 2008;PRAXEDES et al, 2016) ou em países em desenvolvimento (BOUNDA et al, 2013;JOSHUA e KAKKAR, 2015;KAGANSKY et al, 2004;MATALQAH et al, 2013).…”

“…Em nosso estudo incluímos pacientes com diversas indicações clínicas para a anticoagulação oral, sendo as mais frequentes as valvulopatias e arritmias, corroborando com a literatura (ALPHONSA et al, 2015;ÁVILA et al, 2011;CARVALHO et al, 2013;HENN et al, 2008;TANG et al, 2003). No entanto, outras pesquisas conduzidas com esta população tem investigado grupos com doenças específicas, como a avaliação do conhecimento da TAO entre indivíduos apenas com valvulopatias (BOUNDA et al, 2013;CAMPOS et al, 2010;VAN DAME et al, 2010;) ou somente fibrilação atrial (THOMSON et al, 2007;MANSUR et al, 2012;LEIRIA et al, 2010;LAVÍTOLA, et al, 2009;KHAN et al, 2004;LANE et al, 2006;MATALQAH et al, 2013).…”

“…Concomitante ao uso dos ACOs os pacientes relataram o uso de outros medicamentos, e o número médio obtido (em torno de quatro) também foi encontrado por outros pesquisadores (HU et al, 2006;KAGANSKY et al, 2004;MATALQAH et al, 2013) Lane et al (2006). Foi o anticoagulante utilizado por todos os participantes em outras investigações (BAKER et al, 2011;BOUNDA et al, 2013;DAVIS et al, 2005;HU et al, 2006 ;KAGANSKY et al, 2004;KHAN et al, 2004;KHUDAIR et al, 2010;MANSUR et al, 2012;MATALQAH et al, 2013;MAYET, 2015;MAVRI et al, 2015;PLATT et al, 2010;STAFFORD et al, 2012;THOMSON et al, 2007;WINANS et al, 2010;ZEOLLA et al, 2006 (DAVIS et al, 2005;ESMÉRIO et al, 2009;KAGANSKY et al, 2004;PLATT et al, 2010;MENENDEZ-JANDULA et al, 2005;MATALQAH et al, 2013). No que se refere ao processo de construção do IACACO, os 43 itens iniciais (versão 1)…”