Assessment of patients’ warfarin knowledge and anticoagulation control at a joint physician- and pharmacist-managed clinic in China

Abstract

PurposeWarfarin is a widely used anticoagulant with a narrow therapeutic index, and it requires close monitoring and adequate patient education. We aimed to assess the knowledge level regarding warfarin therapy among its users and to identify the factors that significantly influence anticoagulation control.Patients and methodsPatients attending the Warfarin Clinic at the Beijing Tiantan Hospital were enrolled in this study. Patients’ knowledge on warfarin was assessed using a validated Anticoagulation Knowledge Assessment (AKA) questionnaire. Patients’ responses to each question were analyzed to identify areas of improvement in current warfarin education. International normalized ratio (INR) control was defined by the time in therapeutic range (TTR) calculated using the Rosendaal method. Spearman correlation analysis was used to investigate the association between TTR and the independent variables.ResultsA total of 65 patients were enrolled in this study. Eleven questions were answered correctly by <50% of the patients. A total of 858 INR results were recorded; 432 INR values (50.3%) reached the predefined goals, and the mean TTR was 49.8%±24.8%. There were significant associations between TTR and patients’ AKA scores (R=0.356, P=0.004) and between TTR and patients’ educational levels (R=0.339, P=0.006). No significant association was observed between other factors (age and duration of anticoagulation) and TTR. The INR outcome measure was positively associated with patients’ knowledge on warfarin and their educational levels.ConclusionAreas for improvement in patient education have been identified, and processes for educational modification are currently in development.

Impact of a pharmacist-led education and follow-up service on anticoagulation control and safety outcomes at a tertiary hospital in China: a randomised controlled trial

“…The PEFS was designed based on the assumption that INR control could be optimised by enhancing patients’ understanding of warfarin therapy and medication adherence . Therefore, it was not surprising to observe improved knowledge among participants in the PEFS group.…”

“…Nevertheless, providing a single counselling session and an education booklet might not be adequate for Chinese patients because the PEFS group could only answer < 60% of knowledge questions correctly. Similarly, in a small Chinese study, 90.8% of patients had insufficient warfarin knowledge after receiving standardised counselling and written information from a pharmacist . Postdischarge counselling should be added to future warfarin education programmes to consolidate patients’ knowledge .…”

“…In fact, the nation’s first anticoagulation clinic with pharmacist involvement was not established until 2010. Currently, the vast majority of anticoagulation management services are implemented at large, urban hospitals and led by physicians, with pharmacists mainly responsible for patient education due to a lack of prescribing authority and recognition from other healthcare professionals …”

Real-Life International Normalized Ratio Profile in Patients with Non-Valvular Atrial Fibrillation Prescribed Vitamin K Antagonist

“…Наши результаты соответствовали данным, полученным X. Li и соавт. [9], где исследователи показали, что достижение оптимального ВТД тесно связано как с уровнем знаний пациентов об антикоагуляции, так и с уровнем их образования.…”

Efektivitas Edukasi Daring dalam Terapi Warfarin terhadap Kepatuhan Pasien

“…Beberapa studi yang dirangkum pada Tabel 1 terbatas dari kepatuhan responden dalam menjalankan penelitian, jumlah populasi yang terlalu kecil, serta populasi yang tidak merata dari segi ras, status pekerjaan, usia pasien, dan pembagian kelompok penelitian 10,22,23 , sehingga diperlukan studi lebih lanjut dengan memenuhi kekurangankekurangan dari penelitian yang telah dilakukan untuk konfirmasi temuan yang lebih akurat tentang efektivitas dari inovasi pendidikan warfarin secara daring terhadap tercapainya nilai INR yang direkomendasikan ataupun menyelidiki perbandingan efektivitas pendidikan secara daring dengan pendidikan tradisional atau tatap muka 14 . Selain itu, meskipun pengguna warfarin mayoritas adalah kelompok usia <65 tahun 35 , namun masih ditemukan pula pengguna warfarin lansia atau >65 tahun 36 . Hal ini memungkinkan edukasi daring dinilai belum efektif karena mayoritas dari lansia memiliki tingkat melek teknologi sehingga disarankan untuk dilakukan pendidikan tatap muka atau mengkombinasikan antara pendidikan tatap muka dengan penyajian pendidikan dalam bentuk video untuk memaksimalkan penyampaian pendidikan agar lebih efektif.…”