Evaluating Patients’ Understanding of Printed Warfarin Medication Information

Schwartz, Lauren; Mazzola, Nissa; Hoffman, Robert S.; Howland, Mary Ann; Mercurio-Zappala, Maria; Nelson, Lewis S.

doi:10.1177/0897190014544816

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Despite the positive association between HL and the level of knowledge that all studies reflected, it is important to note that whilst different components and skills that inform or determine HL were evaluated in some of the studies discarded [ 47 – 51 ] HL was not specifically measured, which can make it difficult to make comparisons and lead to confusion. Paradigmatically, one of those studies [ 51 ] used two specific HL questions and assessed the readability of materials. However, it is increasingly acknowledged that HL is a much broader concept than readability and encompasses other social and critical elements [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review

et al. 2018

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BackgroundOral anticoagulants (OAC) are widely used in patients with cardiovascular diseases. However, for optimal OAC self-care patients must have skills, among which health literacy (HL) is highlighted. We aimed to describe the relation between HL and self-care in cardiovascular patients on OAC treatment.MethodsElectronic searches were carried out in the PubMed, Scopus, Embase, CINAHL, Web of Science, Cochrane Library, SciELO, IME-Biomedicina, CUIDEN Plus and LILACS databases, limited to Spanish and English language and between January 2000–December 2016. Papers reported on adults older than 18 years, taking OAC by themselves for at least three months. PRISMA guidelines were used for paper selection.ResultsWe identified 142 articles and finally included 10; almost all of them about warfarin. Our results suggest that in patients taking OAC treatments there is a positive relationship between HL and the level of knowledge. In addition, a small percentage of participants on the selected papers recognized the side effects and complications associated with OAC treatment. Lower HL level was associated with greater knowledge deficits and less adherence to treatment.ConclusionThere is a paucity of research evaluating the effect of HL on diverse aspects of OAC treatments. There is a need to expand the evidence base regarding appropriate HL screening tools, determinants of adequate knowledge and optimal behaviours related to OAC self-management.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6070-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review

et al. 2018

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“…Education and materials provided to patients must be easy to understand and readily accessible. Relying on the FDA medication guide for warfarin often leads to unsatisfactory patient knowledge and outcomes [ 14 ]. Several approaches have been successful in leading to a better understanding of warfarin therapy such as one-on-one education [ 15 ], video education from a pharmacist [ 16 ], post-hospital discharge education [ 17 ], and nurse-led anticoagulation clinics [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Warfarin therapy in atrial fibrillation: assessment of patient knowledge of risks and benefits

Fitzgerald

Stancampiano

Kurklinsky

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

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Patients with atrial fibrillation are at an increased risk for stroke, and many benefits from anticoagulation. Despite the emergence of direct oral anticoagulants, many patients continue to rely on warfarin for their anticoagulation due to logistical, pharmacokinetic, clinical, or patient preference issues. Previous work has suggested that outcomes of warfarin therapy are related to patient education/knowledge. We assessed knowledge of indications, benefits, and complications of warfarin therapy in 99 randomly selected patients enrolled in the Warfarin Anticoagulation Clinic at the Mayo Clinic in Florida who were taking warfarin for non-valvular atrial fibrillation. Patients were labeled as 'knowledgeable' or 'not knowledgeable' regarding warfarin therapy according to the results of a cross-sectional questionnaire. The majority of patients in both the knowledgeable and not knowledgeable groups displayed understanding that they were taking warfarin for atrial fibrillation (valvular vs non-valvular atrial fibrillation was not an included answer choice). However, there was a clear lack of knowledge amongst patients with atrial fibrillation in both groups about their stroke risk while on and off warfarin, and their risk of major bleeding or adverse events related to their warfarin therapy. There was only a significant difference between the two groups regarding their knowledge of what increases or decreases the risk of bleeding while on warfarin. There was no major difference between the groups with regards to demographic and medical characteristics, except that 'not knowledgeable' patients tended to have more peripheral vascular disease, ulcer disease, and moderate-severe renal disease compared to 'knowledgeable' patients.

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“…Obtaining accurate, personally relevant information about these risks is challenging ( 5 , 6 , 7 , 8 ). Although the US Food and Drug Administration requires that patients receive a medication guide with most DMARDs, research suggests that many patients have difficulty understanding the information that the guides contain ( 9 , 10 , 11 , 12 , 13 ). This is likely due to both design issues (e.g., nonadherence to plain language guidelines) ( 14 ) and the prevalence of limited health literacy/numeracy skills among patients ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Enhancing Patient Understanding of Medication Risks and Benefits

Blalock

Solow

Reyna

et al. 2021

Arthritis Care & Research

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Objective. To evaluate the effectiveness of 2 interventions, including the DrugFactsBox format for presenting written medication information and the SMART (Strategic Memory Advanced Reasoning Training) program designed to enhance gist (i.e., "bottom-line" meaning) reasoning ability.Methods. We used a 2 Â 2 factorial research design. A total of 286 patients with rheumatoid arthritis were randomly assigned to 1 of 4 groups, including DrugFactsBox with the SMART program, DrugFactsBox without the SMART program, other consumer medication information (CMI) with the SMART program, and other CMI without the SMART program. Data were collected via telephone interviews and online questionnaires at 4 time points, including baseline and 6-week, 3-month, and 6-month time points following baseline. The primary outcome variable was informed decisionmaking, which was defined as making a value-consistent decision concerning use of disease-modifying antirheumatic drugs based on adequate knowledge.Results. We found no main effects for the 2 interventions, either alone or in combination. However, there was a significant interaction between assignment to the SMART/no SMART groups and informed decision-making at baseline. Among participants in the SMART groups who did not meet the criteria for informed decision-making at baseline, 42.5% met the criteria at the 6-month follow-up, compared to 23.6% of participants in the no SMART groups (mean difference 18.9 [95% confidence interval 5.6, 32.2]; P = 0.007). This difference was driven by increased knowledge in the SMART groups. Among participants who met the criteria for informed decision-making at baseline, the difference between the SMART and no SMART groups was not statistically significant.Conclusion. Participation in a theory-driven program to enhance gist reasoning may have a beneficial effect on informed decision-making among patients with inadequate knowledge concerning therapeutic options.ClinicalTrials.gov identifier: NCT02820038. The statements in this work are solely the responsibility of the authors and do not necessarily represent the views of Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee.

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Evaluating Patients’ Understanding of Printed Warfarin Medication Information

Cited by 5 publications

References 21 publications

Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review

Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review

Warfarin therapy in atrial fibrillation: assessment of patient knowledge of risks and benefits

Enhancing Patient Understanding of Medication Risks and Benefits

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