Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Am J Med. 2012 Mar;125(3):258-64. doi: 10.1016/j.amjmed.2011.09.012.
Up to 15% of clinician-ordered doses of injectable pharmacological prophylaxis to prevent venous thromboembolism are not administered. Patient refusal accounts for nearly 50% of these omitted doses. We conducted a prospective cohort study to determine whether a patient education program would improve medication adherence to clinician-ordered injectable prophylactic anticoagulation.
We identified 528 hospitalized patients ordered to receive injectable pharmacological venous thromboembolism prophylaxis. We evaluated the impact of pharmacist-led patient education sessions on medication adherence (defined as the ratio of doses administered to doses scheduled) compared with our historical cohort.
Individualized patient education sessions were conducted within 24 hours of the initial order for prophylactic anticoagulation in 99% of patients. Adherence to clinician-ordered pharmacological venous thromboembolism prophylaxis was higher after the patient education program than in our historical cohort (94.4% vs 89.9%, P <.0001). The proportion of patients receiving 100% of scheduled doses of injectable pharmacological venous thromboembolism prophylaxis was higher after our novel patient education program than in our historical cohort (73.7% vs 62.4%, P=.001). Patient refusal as a reason for omitted doses was less frequent after the patient education program (29.3% vs 43.7%, P=.001).
Pharmacist-led individualized patient education sessions were associated with higher medication adherence to clinician-ordered injectable pharmacological venous thromboembolism prophylaxis and a reduction in patient refusal as a reason for omitted doses. A randomized controlled trial to evaluate the impact of a patient education program on medication adherence to pharmacological venous thromboembolism prophylaxis is warranted.
高达 15%的临床医生开具的用于预防静脉血栓栓塞症的注射用药物预防剂量未被给予。这些遗漏剂量中近 50%是由于患者拒绝。我们进行了一项前瞻性队列研究，以确定患者教育计划是否会提高对临床医生开具的注射用预防性抗凝药物的依从性。
我们确定了 528 名接受注射用药物性静脉血栓栓塞症预防治疗的住院患者。我们评估了药师主导的患者教育课程对药物依从性（定义为给予的剂量与计划剂量的比值）的影响，与我们的历史队列进行比较。
在 99%的患者中，在最初开具预防性抗凝治疗医嘱后的 24 小时内进行了个体化的患者教育课程。与我们的历史队列相比，在接受患者教育计划后，对临床医生开具的药物性静脉血栓栓塞症预防治疗的依从性更高（94.4%比 89.9%，P<0.0001）。在接受我们新的患者教育计划后，接受 100%计划剂量注射用药物性静脉血栓栓塞症预防治疗的患者比例高于我们的历史队列（73.7%比 62.4%，P=0.001）。在接受患者教育计划后，由于患者拒绝而遗漏剂量的比例较低（29.3%比 43.7%，P=0.001）。
药师主导的个体化患者教育课程与更高的药物依从性有关，临床医生开具的注射用药物性静脉血栓栓塞症预防治疗以及由于患者拒绝而遗漏剂量的情况减少。需要进行一项随机对照试验，以评估患者教育计划对药物性静脉血栓栓塞症预防治疗的药物依从性的影响。
