To investigate the effect of a randomised controlled trial of a nurse-led structured educational programme compared to standard care on patient knowledge when starting anticoagulant therapy with warfarin.
Methods
45 patients commencing warfarin during an inpatient admission were randomised into either a control group receiving ‘usual’ care, or an experimental group with structured counselling and provision of an educational video. Identical questionnaires assessing knowledge of anticoagulation therapy were applied at discharge and again 3 months later.
Results
Patients receiving a structured educational approach had significantly better knowledge about their therapy both at hospital discharge and at 3 months post discharge (p = <0.001 and p = 0.038 respectively). Secondary outcomes measured also showed a higher level of patient satisfaction (p = 0.017) and time in target INR range (56.7% versus 48.1%) in the educational arm.
Conclusions
A formal and structured nurse-led educational package at the initiation of anticoagulant treatment with warfarin treatment improves patient knowledge.
AnsellJEButtaroMLThomasOV (1997) Consensus guidelines for coordinated outpatient oral anticoagulation therapy management. Anticoagulation Guidelines Task Force. The Annals of Pharmacotherapy31(5): 604–615.
2.
ArnstenJHGelfandJMSingerDE (1997) Determinants of compliance with anticoagulation: a case-control study. The American Journal of Medicine103(1): 11–17.
3.
BaglinTPRosePE (1998) Guidelines on oral anticoagulation: third edition. British Journal of Haematology101(2): 374–387.
4.
BaglinTPKeelingDMWatsonHG (2006) Guidelines on oral anticoagulation (warfarin): third edition – 2005 update. British Journal of Haematology132(3): 277–285.
BowlesL (1996) How much should patients be told about their medication?British Journal of Nursing5(3): 156–161.
8.
BriggsALJacksonTRBruceS (2005) The development and performance validation of a tool to assess patient anticoagulation knowledge. Research in Social and Administrative Pharmacy1(1): 40–59.
9.
ClarenceM (1992) Ensuring compliance with drug regimes. Nursing Standard7(6): 24–26.
10.
GadisseurAPBreukink-EngbersWGvan der MeerFJ (2003) Comparison of the quality of oral anticoagulant therapy through patient self-management and management by specialised anticoagulation clinics in the Netherlands. Archives of Internal Medicine163(21): 2639–2646.
11.
Gras-ChampelVVoyerAGuillaume (2006) Quality evaluation of the management of oral anticoagulation therapy (OAT): the awareness of treating physicians and the education of patients needs to be improved. American Journal of Therapeutics13(3): 223–228.
12.
HeneghanCAlonso-CoelloPGarcia-AlaminoJM (2006) Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet367(9508): 404–411.
KhanTIKamaliFKestevenP (2004) The value of education and self-monitoring in the management of warfarin therapy in older patients with unstable control of anticoagulation. British Journal of Haematology126(4): 557–664.
15.
KumarSHaighJRRhodesLE (1989) Poor compliance is a major factor in unstable outpatient control of anticoagulant therapy. Thrombosis and Haemostasis62(2): 729–732.
16.
LaneDAPonsfordJShelleyA (2006) Patient knowledge and perceptions of atrial fibrillation and anticoagulant therapy: effects of an educational programme: The West Birmingham Atrial Fibrillation Project. British Journal of Cardiology110(3): 354–358.
17.
LoweCJRaynorDKCourtneyEA (1995) Effects of a self medication programme on knowledge of drugs and compliance of treatment in elderly patients. British Medical Journal310(6989): 1229–1231.
18.
McCormackPMStinsonJCHemeryckL (1997) Audit of an anticoagulant clinic: doctor and patient knowledge. Irish Medical Journal90: 192–193.
19.
MurphyJCosterG (1997) Issues in patient compliance. Drugs54(6): 797–800.
NochowitzBShapiroNLNutescuEA (2009) Effect of a warfarin adherence aid on anticoagulation control in an inner-city anticoagulation clinic population. Ann Pharmacother43(7): 1165–1172F.
22.
SawickiP (1999) A structured teaching and self-management program for patients receiving oral anticoagulation: a randomized controlled trial. Journal of the American Medical Association281(2): 145–150.
23.
StoneSHoldenAKnapticN (1989) Comparison between videotape and personalised patient education for anticoagulant therapy. The Journal of Family Practice29(1): 55–57.
24.
TaylorFCRamsayMETanG (1994) Evaluation of patients’ knowledge about anticoagulant treatment. Quality in Health Care3(2): 79–85.
25.
TaylorFCGaminaraECohenH (1997) Evaluation of a nurse specialist anticoagulation service. Clinical Laboratory Haematology19(4): 267–272.
26.
WiffinA (1995) An assessment of procedures. Nursing Times91(28): 31–32.
27.
WoffordJLWellsMDSinghS (2008) Best strategies for patient education about anticoagulation with warfarin: a systematic review. BMC Health Services Research8: 40–48.
28.
YunkerNSFlintNBCarpenterED (1990) Self medication on a rehabilitation unit. Patient Education and Counselling15(3): 261–268.
