Impact of an electronic medium delivery of warfarin education in a low income, minority outpatient population: a pilot intervention study

Abstract

Background Warfarin is classified as a high-alert medication for ambulatory healthcare and safe guards for high-alert medications are necessary, including the practice of mandatory patient education. The high cost of hospitalizations related to adverse events combined with the average bleeding event rate of 7–8% in spite of routine patient education, suggests the importance of new approaches to standardized health education on warfarin. We sought to evaluate the impact of a warfarin educational video using an electronic tablet on patient knowledge and to determine patients’ satisfaction with the use of an electronic tablet for educational purposes in outpatient clinics serving a low income, minority population. Methods A warfarin educational video delivered on an electronic tablet (iPad) was delivered at two pharmacist-managed anticoagulation clinics to uninsured patients whose annual income is equal or less than two hundred percent below the poverty level were offered. Patients ( n = 18) completed a pre-video and post-video knowledge test on warfarin before and after viewing the warfarin educational video on an electronic tablet and a follow-up test to measure the retention of knowledge and a patient satisfaction survey at 60 days. The primary outcome was change in knowledge test scores. Other outcome measures included adherence rates, adverse events, time in therapeutic INR range, and patient-reported satisfaction scores. Results The majority of patients were uninsured men taking warfarin for atrial fibrillation ( n = 5). The median scores at post-video knowledge test and follow-up knowledge test were significantly higher than that for the pre-knowledge test (12 (11–12) vs. 10(8–11), p < 0.001). The study group had a ‘time in therapeutic INR’ range of 56.3%, a rate of adverse events of 24.5%, and a self-reported adherence rate to warfarin of 94.1%. The majority of patients also had positive responses to the patient satisfaction survey. Conclusions Patient education delivered via iPad to facilitate knowledge of medication can serve as a useful tool for educating patients about warfarin and warfarin therapy. Use of an electronic medium may be a unique way to provide standard medication education to patients. Trial registration The study was retrospectively registered with: NCT03650777 ; 9/18/18.

Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study (Preprint)

“…Based on research evidence and prior experiences, the tablet application, the e-learning platform, and the website were implemented to strengthen health literacy, encourage guideline fidelity, and provide a subsequent change in antibiotic use habits for ARTI in German primary care. Prior studies used tablet computers to specifically disseminate health literacy in adults [30][31][32], for self-management programs for chronic diseases [33], diagnostics [34,35], interventions for parents and children [36][37][38][39][40], coping strategies after diverse surgeries [8,41], or as tracking functions for aims of weight reduction [42] and general fitness [43,44]. However, the findings of this study demonstrate a variety of challenges and a reluctance toward using digital information tools in German primary care practices for both patients and health professionals.…”

Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study

“…Instead, perceptions about innovation characteristics were more dominant, leading to a preference for more familiar and traditional solutions. Prior studies also used multimedia approaches to provide information in a digitally enhanced manner and offered printed information, videos, or individualized risk assessments [ 31 , 32 ]. In contrast to our findings, those studies showed significant effects of the use of tablets as educational devices for patients.…”

Efektivitas Edukasi Daring dalam Terapi Warfarin terhadap Kepatuhan Pasien

“…Pasien dengan TTR rendah (<65%) berisiko lebih tinggi terhadap hasil yang buruk. Tercapainya nilai TTR yang tinggi dan kecilnya angka kejadian merugikan sebagai bukti dari pasien memahami pendidikan dan meningkatnya kepatuhan dalam terapi warfarin 13,19,23 . Sama halnya dengan pemberian video pendidikan warfarin, pendidikan dalam sebuah program PSM ini juga memberikan kepatuhan yang tinggi karena dapat diakses kapan saja.…”

“…Penelitian yang dilakukan di Texas, Amerika Serikat ini memperlihatkan median skor tes pengetahuan dan kepatuhan pasien setelah menonton video pendidikan lebih tinggi (dengan skor 12) jika dibandingkan dengan sebelum menonton video pendidikan (dengan skor 10). Penilaian pengetahuan dan kepatuhan pasien menggunakan kuesioner AKA yang mengandung 29 pertanyaan dengan kemungkinan skor tertinggi 12 dan terendah 013 . Peningkatan skor tes pengetahuan juga dilaporkan oleh penelitian Moore et al tahun 2015 di Amerika Serikat untuk pasien yang diberikan intervensi pendidikan dan konseling mengenai warfarin dalam bentuk video dari 60,8% menjadi 74,3% dibandingkan dengan pasien perawatan biasa dan menerima konseling oral yaitu dari 60,5% menjadi 71,3%15 .…”

“…Peningkatan skor tes pengetahuan juga dilaporkan oleh penelitian Moore et al tahun 2015 di Amerika Serikat untuk pasien yang diberikan intervensi pendidikan dan konseling mengenai warfarin dalam bentuk video dari 60,8% menjadi 74,3% dibandingkan dengan pasien perawatan biasa dan menerima konseling oral yaitu dari 60,5% menjadi 71,3%15 . Selain itu, nilai rata-rata TTR pasien yaitu 56,3% dan hanya ada satu orang yang dilaporkan mengalami efek samping13 .Perbedaan TTR yang signifikan juga terjadi ketika pasien diberikan intervensi pendidikan warfarin melalui video DVD pada penelitian Clarkesmith et al tahun 2013, dimana pada kelompok intervensi menunjukkan nilai TTR 76,2% dibandingkan dengan kelompok usual care yaitu 71,3% pada 6 bulan sedangkan perbedaan tidak signifikan pada 12 bulan masing-masing TTR kelompok adalah 76% dan 70%.Skor pengetahuan pasien pada 6 bulan menunjukkan bahwa pengetahuan pasien tentang penyakit dan perawatannya masih dapat dipertahankan dan pasien cenderung untuk tetap berada dalam kisaran terapi target. Ada kemungkinan bahwa meningkatkan pengetahuan pasien dapat meningkatkan pula kepatuhan pasien terkait pengobatannya.…”