Self-report instruments for assessing adherence to warfarin therapy: a systematic review

Abstract

Background The assessment of adherence to warfarin therapy is useful in clinical practice due to its wide variability in dose-response and risks of complications. The aim of this study was to investigate validated instruments used to assess adherence to warfarin therapy. Methods Information was collected from the MEDLINE (PubMed), LILACS, EMBASE, and Cochrane Library databases. Search strategies were applied for each database, with no time limit or language restriction. Inclusion criteria consisted of study participants of ≥ 18 years of age, from both sexes, on chronic anticoagulation with warfarin for any indication and the use of validated instruments to assess adherence to warfarin therapy. Exclusion criteria consisted of duplicate articles, narrative or systematic reviews, and meta-analyses, as well as case reports/series and experimental studies involving animals. Two independent reviewers performed the following steps: evaluation of titles/abstracts, selection of studies after full reading, data extraction, and evaluation of potential bias. Discrepancies were resolved by a third reviewer. Results Overall, 19 articles were selected for this systematic review, including 17 cross-sectional studies, one cohort study, and one quasi-experimental study, published from 2009 to 2019. The validated instruments identified in this review were Morisky Medication Adherence Scale (MMAS), the eight-item Morisky Medication Adherence Scale (MMAS-8), Measurement of Treatment Adherence (MTA), and Brief Medication Questionnaire (BMQ). Only MMAS-8 was tested for reliability, using the internal consistency assessment, with Cronbach's α range 0.56-0.71. Conclusions This review highlighted a gap in knowledge regarding the scarcity of validated instruments to assess adherence to warfarin therapy. Limitations were found in instruments that comprised the assessment of the isolated use of medication and the lack of analysis of other relevant therapeutic aspects. Future studies are needed to develop and validate more comprehensive instruments in an attempt to assess adherence to warfarin therapy. PROSPERO Registration number CRD42019128324 Keywords Anticoagulants • Medication Adherence • Validation studies • Warfarin Key points• Adherence to prescribed drugs is currently a major obstacle for outpatients to achieve success in drug therapy. The assessment of adherence behaviors is useful to substantiate intervention strategies that seek to bring about changes in health outcomes as a consequence of drug therapies. • No adapted and validated instruments addressing specificities of warfarin therapy were found in this review. Current instruments to assess adherence to warfarin therapy address the isolated use of the medication with no items covering other relevant aspects of therapy, such as diet and drug interactions. • Further studies are needed to investigate specific scales in order to evaluate adherence to warfarin therapy, employing the assessment of their psychometric properties and applicability in clinical practiceExtended author inf...

Fatores Estressores Na Atividade Do Enfermeiro

“…A mortalidade da população que reinterna foi de 35,4% (p=0,3619 no teste Chi quadrado comparativamente a mortalidade geral). 88 (31,4) 37 (13,2) 07 (2,5) 12 (4,3) 01 (0,3 (5,6) 02 (100) 0 04 (5,2) 09 (3,1) 04 (4,5) 02 ( 50) 02 ( 50) 05 (5,6) 33 (10,3) 13 (15,3) 06 (46,2) 07 (53,8) 20 (23,5) 27 (8,2) 10 (9,7) 06 (( 60) 04 ( 40) 17 (16,5) 21 (7,5) 05 (6,6) 01 ( 20) 04 ( 80 Ao se investigar os motivos de internação dos pacientes que faleceram, constatou se que a maior parte foi daqueles que internaram por disfunções pulmonares, 49,8% (n = 281), seguidos dos pacientes da gastroenterologia 42,9% (n = 49); Constatou-se que apesar de o maior número de internações neste setor terem sido pelo sistema cardiovascular, este foi responsável por apenas 23,1% (n = 368) dos óbitos ocorridos no período avaliado; A frequência das especialidades no modo de morrer está descritas na tabela 02. A taxa de óbito entre os pacientes que reinternaram na UTI foi elevada (35,4% versus a mortalidade geral, 28,7%), dos quais 51,5% (n = 33) morreram antes de completar 24 horas de reinternação no setor.…”

“…Nesse contexto, destaca-se o trabalho da enfermagem no combate a COVID-19, como foi apontado nesse estudo, em que os profissionais tiveram que enfrentar um cenário de trabalho atípico e adverso, elaborando estratégias de cuidado para o tratamento de uma doença provocada por um vírus cujo comportamento no corpo humano ainda era desconhecido (Paixão et al, 2021;Silva et al, 2021).…”

“…Assim, a enfermagem, embora parte de uma equipe multiprofissional, assumiu em muitos momentos a liderança no contexto pandêmico, organizando e prestando as ações de saúde, evidenciando seu protagonismo na pandemia que, com sua atuação eficaz, efetiva e segura, foi primordial para o combate à doença, reforçando sua relevância profissional e social da profissão (Silva et al, 2021).…”

“…Prática clínica baseada em evidências 2 Profissionais de saúde 1, 2, 3,4,6,7,25,32,35,37,50,51,58,100,111,124,129,139,141,143,145,147 Promoção da saúde 11, 44, 99, 100, 115…”

Factors associated with nonadherence to the use of coumarin derivatives or direct oral anticoagulants: A systematic review of observational studies

“…Even with the availability of some instruments to measure nonadherence, none is considered a gold standard 58 . So far, there is still a gap in the literature of validated indirect methods that allow measurement of this phenomenon with high reliability 59 . Subjectivity in the use of methods in health can lead to different interpretations and often affects the estimate of the investigated outcome, leading to measurement bias 60 .…”