Hu Amanda, Chow Chi-Ming, Dao Diem, Errett Lee, Keith Mary
Faculty of Medicine, University of Toronto, Toronto, Ontario.
J Cardiovasc Nurs. 2006 May-Jun;21(3):169-75; quiz 176-7. doi: 10.1097/00005082-200605000-00003.
Patients with mechanical heart valves must follow lifelong warfarin therapy. Warfarin, however, is a difficult drug to manage because it has a narrow therapeutic window and potentially serious side effects. Successful anticoagulation treatment is dependent upon the patient's knowledge of this drug; however, little is known regarding the determinants of such knowledge. Therefore, the purpose of this study was to determine the influence of both in-hospital teaching practices as well as socioeconomic status and demographic variables on patients' knowledge of warfarin therapy.
A telephone survey was conducted among 100 patients 3 to 6 months after mechanical heart valve replacement. A previously validated 20-item questionnaire was used to measure the patient's knowledge of warfarin, its side effects, and vitamin K food sources. Demographic information, socioeconomic status data, and medical education information were also collected. Knowledge scores were compared using the Student t test or one-way analysis of variance. Variables with P < or = .2 on univariate analysis were entered in multiple stepwise regression analysis.
Sixty-one percent of participants had scores indicative of insufficient knowledge of warfarin therapy (score < or = 80%). Age was negatively related to warfarin knowledge scores (r = 0.27, P = .007). Patients with family incomes greater than $25,000, who had greater than a grade 8 education, and who were employed or self-employed had significantly higher warfarin knowledge scores (P = .007, P = .002, and P = .001, respectively). Gender, ethnicity, and warfarin therapy before surgery were not related to warfarin knowledge scores. Furthermore, none of the in-hospital teaching practices significantly influenced knowledge scores, whereas receiving postdischarge community counseling significantly improved knowledge scores (P = .001). Multivariate regression analysis revealed that understanding the concept of International Normalized Ratio, knowing the acronym, age, and receiving community counseling after discharge were the strongest predictors of warfarin knowledge. Accessing postdischarge counseling resulted in significantly improved warfarin knowledge scores. Because improved knowledge has been associated with improved compliance and control, our findings support the need to develop a comprehensive postdischarge education program or at least to ensure that patients have access to a community counselor to compliment the in-hospital education program.
机械心脏瓣膜置换术后患者必须接受终身华法林治疗。然而，华法林是一种难以管理的药物，因为其治疗窗狭窄且存在潜在的严重副作用。成功的抗凝治疗取决于患者对该药物的了解；然而，对于这种了解的决定因素知之甚少。因此，本研究的目的是确定住院期间的教学实践以及社会经济地位和人口统计学变量对患者对华法林治疗知识的影响。
在100例机械心脏瓣膜置换术后3至6个月的患者中进行电话调查。使用一份先前经过验证的包含20个条目的问卷来评估患者对华法林、其副作用以及维生素K食物来源的了解。同时收集人口统计学信息、社会经济地位数据和医学教育信息。知识得分采用Student t检验或单因素方差分析进行比较。单因素分析中P≤0.2的变量纳入多因素逐步回归分析。
61%的参与者得分表明对华法林治疗知识了解不足（得分≤80%）。年龄与华法林知识得分呈负相关（r = 0.27，P = 0.007）。家庭收入超过25000美元、教育程度高于八年级且受雇或自营职业的患者华法林知识得分显著更高（分别为P = 0.007、P = 0.002和P = 0.001）。性别、种族和术前华法林治疗与华法林知识得分无关。此外，住院期间的教学实践均未显著影响知识得分，而出院后接受社区咨询显著提高了知识得分（P = 0.001）。多因素回归分析显示，理解国际标准化比值的概念、知道其首字母缩写、年龄以及出院后接受社区咨询是华法林知识的最强预测因素。获得出院后咨询显著提高了华法林知识得分。由于知识的提高与依从性和控制的改善相关，我们的研究结果支持需要制定全面的出院后教育计划，或者至少确保患者能够获得社区咨询人员以补充住院教育计划。
