Authors (including presenting author) :
Chiu SH(1), Cheung HW(2), Chiu HY(3), Leung YW(4), Sze To TL(5)
Affiliation :
(1) Princess Margaret Hospital
(2) Prince of Wales Hospital
(3) Queen Mary Hospital
(4) United Christian Hospital
(5) Ruttonjee Hospital
Introduction :
Warfarin is a common oral anticoagulant (OAC), and has been consistently shown to reduce the risk of stroke in patients with atrial fibrillation (AF) by more than 60%. However, the stability of warfarin is easily affected by food and drug interactions. Under or over-warfarinization has been found to be associated with a number of complications including thromboembolic event, major bleeding, and even death. Patients with insufficient knowledge are considered have a higher risk of complications.
In Hong Kong, warfarin education varies among hospitals in respect to: what to educate (e.g. contents); when to perform (e.g. newly start or non-compliance); how to perform (e.g. individual, group, or video); and who to perform education (e.g. nurse, pharmacist).
Objectives :
1. To tailor-made patient education to tackle individual problems
2. To raise patient’s knowledge level of warfarin therapy through a standardized content
Methodology :
Cardiac patients on warfarin, according to the inclusive criteria with INR (international normalized ratio) out of therapeutic range were recruited. A face-to-face one-off education was conducted by trained nurses through a standardized education content, consisting of 9 items. Patients’ individual problem was tackled. Patients’ knowledge on warfarin was assessed using a self-developed and validated Chinese version Warfarin Knowledge Assessment (WKA) questionnaire comprising 12 questions before, immediate after and 2-3 months after education. The primary endpoint was knowledge about treatment. The secondary endpoints were measured from 3 months before to 3 months after education provided. The main secondary endpoint was time spent in the INR target range, as assessed by Rosendaal Linear Interpolation method. Other secondary endpoints were major complications that had occurred.
Result & Outcome :
There were 36 patients from 5 hospitals were recruited from March to August 2019. Only 8(22.2%) patients taking warfarin within 1 year, half of the patents (50%) taking warfarin more than 5 years. There was no relationship in scores were seen based on patient’s demographic characteristics: age, sex and educational level. 4(11.1%) patients reported missing dose 2-3 times, and 2(5.5%) patients even reported missing dose for 8-9 times within last 3 months.
Before patient education, 16(44.4%) patients scored below 50%. Only 2(5.5%) patients achieved a score of 100%. Immediate after education, none of the patients failed to achieve the passing score. 25(69.4%) patients answered all questions correctly. The average passing score was significantly increased from pre-education 56.9% to 80.8% post 2-3 months’ education.
Time in therapeutic INR range improved from 39.4% to 49.5%. Previous complications were reported by 2(5.5%) patients due to heavy haematuria and sinus thrombosis. Except the latter patient who was complicated with ischemic stroke, no other adverse events had occurred up to the end of the observation period.
This trial shows that standardized, personal patient education is practically achievable and durably improves warfarin patients’ knowledge and time in therapeutic INR range. It recommends that standardized patient education ought to be a part of routine care.
