Evaluation of patients’ knowledge about oral anticoagulant medicines and use of alert cards by community pharmacists

Abstract

Background Anticoagulants continue to pose high risk of harm to patients despite the discovery of novel direct-acting oral anticoagulant agents that require less monitoring than warfarin. Objective To evaluate patients’ knowledge about their oral anticoagulants and the potential role for community pharmacists in optimising safety. Setting Community pharmacies in England. Methods An online survey-based evaluation conducted over a 5-month period to ascertain patients’ knowledge, use of anticoagulant alert cards, compliance with national monitoring requirements for warfarin, and frequency and nature of community pharmacist involvement in optimisation. Differences between patients on direct-acting oral anticoagulant agents and warfarin were assessed using Chi squared tests. Main outcome measure Patients’ knowledge and use of anticoagulant alert cards. Results A total of 1515 pharmacies participated. Of 22,624 patients, 97% knew that they were taking anticoagulants; 20% had alert cards with them at time of dispensing; 17% had no card and 10% refuted their usefulness. Patients on warfarin were more aware of interactions with over-the-counter or herbal medicines than those on direct-acting oral anticoagulant agents. Of the patients on warfarin, 82% confirmed monitoring in the previous 12 weeks in accordance with national standards, with the international normalised ratio value known for 76%. Pharmacists intervened in a fifth of the patients to issue an alert card, contact the general practitioner for a change in the prescription or due to interacting medicines. Conclusion Patients had reasonable knowledge of their anticoagulation therapy, but areas for improvement were identified. Community pharmacists are well placed to optimise the safe use of anticoagulants.

The burden of systemic corticosteroid use in asthma management in Asia

“…99 Educating patients about the importance of taking inhaled therapies as prescribed, good inhaler technique and the risks associated with SCS may encourage patients to favour medications with less risk of adverse outcomes than SCS. If SCS therapy is required, it is important that patients are aware of the risks, which could be presented in the form of a reference card (similar to anticoagulant alert cards used by patients treated with warfarin) 100 that provides key information such as common adverse events and SCS dosing limits and could also be used to document SCS exposure levels over time. Educating patients on how to more effectively self-assess asthma severity and control would also help to match the proper treatment approach to the patient's current need.…”

Atrial fibrillation: symptoms, diagnosis and management

“…Research 3 has shown that pharmacists can successfully intervene when a medicine is newly prescribed, with repeated follow up in the short term, to increase effective medicine taking for the treatment of a long-term condition. The NMS significantly increased the proportion of patients adhering to their new medicine by about 10%, 4 compared with normal practice.…”

“…In the 2017-18 audit, 11% of patients received their anticoagulant medicine in an MDS compliance aid. 3 For DOACs, dabigatran is the only agent where the manufacturer advises that it should be left in the original foil wrapping (i.e. not repackaged) to protect from moisture and it is important that pharmacies are aware of this.…”

“…Since then, new direct-acting oral anticoagulants (DOACs) have come into widespread use. Although the principles of the 2007 alert still apply, some aspects, such as regular International Normalised Ratio (INR) monitoring and dietary considerations, are not relevant for the newer medicines.In 2017-18 an audit of oral anticoagulant safety was conducted in more than 1,500 community pharmacies across England, reporting a cohort of more than 22,000 patients3 . The audit was based on requirements in the 2007 alert and known errors reported to the National Reporting and Learning System.…”

Anticoagulation Interventions by Pharmacists in Acute Care

“…This may be explained by departmental prioritization of optimizing medications before discharge and relying on our well-positioned community pharmacy colleagues to provide education once patients' medication therapy has been optimized. 11,12 The Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010 recommended a transition in practice from warfarin to direct oral anticoagulants (DOACs) as preferred first-line therapy, 13 which may have affected pharmacists' anticoagulant interventions during the study period. However, given that the AIM High system was implemented in 2015 and DOACs have been the standard of care in Regina (according to the anticoagulant clinical practice standard) since 2014, the effect of the 2010 guidelines on local data is thought to be minimal.…”