Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tas., Australia.
J Clin Pharm Ther. 2012 Aug;37(4):410-4. doi: 10.1111/j.1365-2710.2011.01308.x. Epub 2011 Oct 20.
Warfarin is recognized as a high-risk medication for adverse events, and the risks are particularly heightened in the period immediately following a patient's discharge from hospital. This qualitative study aimed to explore the experiences of Australian patients and healthcare professionals of warfarin management in the post-discharge period and identify the benefits and deficiencies of existing systems, to inform the development of a model for a new collaborative post-discharge warfarin management service.
Healthcare professionals, professional organization representatives and patients recently discharged from hospital taking warfarin (consumers) were recruited via purposive, criterion-based sampling within two Australian states. Semi-structured telephone interviews were conducted between August and October 2008 using standard discussion guides. Data were manually analyzed to identify emergent themes using a phenomenological approach.
Forty-seven participants were involved in the telephone interviews. Three major themes emerged: (i) appropriate warfarin education is integral to effective warfarin management, (ii) problems occur in communication along the continuum of care and (iii) home-delivered services are valuable to both patients and healthcare professionals.
Although high-quality warfarin education and effective communication at the hospital-community interface were identified as important in post-discharge warfarin management, deficiencies were perceived within current systems. The role of home-delivered services in ensuring timely follow-up and promoting continuity of care was recognized. Previous studies exploring anticoagulation management in other settings have identified similar themes. Post-discharge management should therefore focus on providing patients with a solid foundation to minimize future problems.
Addressing the three identified facets of care within a new, collaborative post-discharge warfarin management service may address the perceived deficiencies in existing systems. Improvements may result in the short- and longer-term health outcomes of patients discharged from hospital taking warfarin, including a reduction in their risk of adverse events.
华法林被认为是一种易发生不良反应的高危药物，尤其在患者出院后立即存在较高风险。本定性研究旨在探讨澳大利亚患者和医护人员对华法林出院后管理的经验，明确现有系统的优势和不足，为开发新的协作式出院后华法林管理服务模式提供信息。
通过在澳大利亚两个州进行基于标准的目标和基准抽样，招募了最近出院服用华法林的医护人员、专业组织代表和患者（消费者）。2008 年 8 月至 10 月间采用标准讨论指南进行了半结构化电话访谈。采用现象学方法对手动分析中出现的主题进行了识别。
共有 47 名参与者参与了电话访谈。出现了三个主要主题：（i）适当的华法林教育是有效管理华法林的基础，（ii）在整个医疗保健过程中存在沟通问题，（iii）上门服务对患者和医护人员都有价值。
尽管在出院后的华法林管理中，高质量的华法林教育和医院-社区界面的有效沟通被认为很重要，但目前的系统仍存在不足。家庭服务在确保及时随访和促进医疗保健连续性方面的作用得到了认可。其他环境中探索抗凝管理的先前研究也确定了类似的主题。出院后的管理应侧重于为患者提供坚实的基础，以最大程度地减少未来的问题。
在新的协作式出院后华法林管理服务中解决这三个被确定的护理方面，可能会改善现有系统中存在的不足。这可能会改善出院后服用华法林的患者的短期和长期健康结果，包括降低不良反应风险。
