Kathleen M Jenner1, Brandon J Simmons2, Thomas Delate3, Nathan P Clark4, Deanna Kurz5, Daniel M Witt6. 1. Clinical Pharmacy Specialist with the Clinical Pharmacy Anticoagulation and Anemia Service for Kaiser Permanente Colorado in Aurora. kathleen.m.jenner@kp.org. 2. Clinical Pharmacy Specialist with the Clinical Pharmacy Anticoagulation and Anemia Service for Kaiser Permanente Colorado in Aurora. brandon.x.simmons@kp.org. 3. Clinical Pharmacy Research Scientist with the Clinical Pharmacy Research Department for Kaiser Permanente Colorado in Aurora. tom.delate@kp.org. 4. Supervisor and Clinical Pharmacy Specialist with the Clinical Pharmacy Anticoagulation and Anemia Service for Kaiser Permanente Colorado in Aurora. nathan.clark@kp.org. 5. Senior Project Manager with the Clinical Pharmacy Research Department for Kaiser Permanente Colorado in Aurora. deanna.kurz@kp.org. 6. Clinical Professor and Vice Chair in the Department of Pharmacotherapy and Assistant Dean for Clinical Affairs at the University of Utah College of Pharmacy in Salt Lake City. dan.witt@pharm.utah.edu.
Abstract
INTRODUCTION: Although improved anticoagulation therapy outcomes have been demonstrated in clinical trials evaluating warfarin patient self-management (PSM) programs, these studies did not provide detailed information regarding PSM program development and patient training. OBJECTIVE: To evaluate the feasibility of and methods for developing and administering an education program to support a novel pilot warfarin PSM program. METHODS: Patients receiving warfarin for atrial fibrillation were recruited to participate in a prospective, intervention-only, open-label pilot PSM program that released venipuncture international normalized ratio results to patients via a secure, online Web site. To support the pilot, a warfarin PSM education program with a dosing algorithm was developed and delivered to patients during a two-hour classroom session. MAIN OUTCOME MEASURE: A comparison of participants' PSM competency test scores before and after attending the PSM program. RESULTS: Forty-four patients attended the education program. The mean age of participants was 71 years and 50% were women. Patients declining study participation were older (p = 0.003) and had a greater burden of chronic disease (p = 0.005) than participants. Following PSM training, the mean competency score improved from 55.8% to 88.8% (p < 0.001), and the proportion achieving a passing score increased from 34.9% to 95.3% (p < 0.001). In the poststudy survey, 100% of responders perceived that PSM training prepared them to self-manage warfarin, and 92.9% of responders were comfortable changing warfarin doses on their own. CONCLUSION: Developing and administering a warfarin PSM education program for patients with atrial fibrillation was feasible. Improvement in PSM competency and high levels of self-reported comfort with warfarin PSM were identified.
INTRODUCTION: Although improved anticoagulation therapy outcomes have been demonstrated in clinical trials evaluating warfarinpatient self-management (PSM) programs, these studies did not provide detailed information regarding PSM program development and patient training. OBJECTIVE: To evaluate the feasibility of and methods for developing and administering an education program to support a novel pilot warfarin PSM program. METHODS:Patients receiving warfarin for atrial fibrillation were recruited to participate in a prospective, intervention-only, open-label pilot PSM program that released venipuncture international normalized ratio results to patients via a secure, online Web site. To support the pilot, a warfarin PSM education program with a dosing algorithm was developed and delivered to patients during a two-hour classroom session. MAIN OUTCOME MEASURE: A comparison of participants' PSM competency test scores before and after attending the PSM program. RESULTS: Forty-four patients attended the education program. The mean age of participants was 71 years and 50% were women. Patients declining study participation were older (p = 0.003) and had a greater burden of chronic disease (p = 0.005) than participants. Following PSM training, the mean competency score improved from 55.8% to 88.8% (p < 0.001), and the proportion achieving a passing score increased from 34.9% to 95.3% (p < 0.001). In the poststudy survey, 100% of responders perceived that PSM training prepared them to self-manage warfarin, and 92.9% of responders were comfortable changing warfarin doses on their own. CONCLUSION: Developing and administering a warfarin PSM education program for patients with atrial fibrillation was feasible. Improvement in PSM competency and high levels of self-reported comfort with warfarin PSM were identified.
Authors: M E Cromheecke; M Levi; L P Colly; B J de Mol; M H Prins; B A Hutten; R Mak; K C Keyzers; H R Büller Journal: Lancet Date: 2000-07-08 Impact factor: 79.321