Stafford Leanne, van Tienen Ella C, Bereznicki Luke R E, Peterson Gregory M
Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia.
Int J Pharm Pract. 2012 Dec;20(6):384-9. doi: 10.1111/j.2042-7174.2012.00217.x. Epub 2012 Jun 10.
Good warfarin knowledge is important for optimal patient outcomes, but barriers exist to effective education and warfarin knowledge is often poor. This study aimed to explore the educational outcomes of home-based warfarin education provided by trained pharmacists.
In a prospective, non-randomised, controlled cohort trial, patients received either usual community-based post-discharge care or a post-discharge warfarin management service, including warfarin education by trained pharmacists during two or three home visits. Patients' warfarin knowledge was assessed at 8 and 90 days post-discharge using the Oral Anticoagulation Knowledge test.
One hundred and thirty-nine patients were recruited into the usual care group between November 2008 and August 2009, and 129 into the intervention group between May and December 2009. Pharmacist-delivered warfarin education was associated with a significant difference between the intervention patients' baseline and day 8 mean warfarin knowledge scores of 64.5% (95% confidence interval (CI) 61.0-68.5%) and 78.0% (95% CI 74.5-81.5%; P < 0.001), respectively. The intervention patients also scored significantly higher than the usual care patients at day 8 (65.0%, 95% CI 61.5-68.0%; P < 0.001), but not at day 90.
Use of an existing healthcare framework overcame several systemic barriers by facilitating warfarin education in patients' homes. While the intervention was associated with better short-term warfarin knowledge, follow-up may be required to optimise its benefits. Widespread implementation of home-based warfarin education by pharmacists has the potential to contribute significantly to improved outcomes from warfarin therapy.
良好的华法林知识对于患者获得最佳治疗效果至关重要，但有效教育存在障碍，且华法林知识往往较差。本研究旨在探讨由经过培训的药剂师提供的家庭华法林教育的教育效果。
在一项前瞻性、非随机、对照队列试验中，患者接受常规的社区出院后护理或出院后华法林管理服务，包括在两到三次家访期间由经过培训的药剂师进行华法林教育。在出院后8天和90天使用口服抗凝知识测试评估患者的华法林知识。
2008年11月至2009年8月期间，139名患者被纳入常规护理组，2009年5月至12月期间，129名患者被纳入干预组。药剂师提供的华法林教育与干预组患者基线时和第8天的平均华法林知识得分之间存在显著差异，分别为64.5%（95%置信区间（CI）61.0 - 68.5%）和78.0%（95%CI 74.5 - 81.5%；P < 0.001）。干预组患者在第8天的得分也显著高于常规护理组患者（65.0%，95%CI 61.5 - 68.0%；P < 0.001），但在第90天并非如此。
利用现有的医疗保健框架通过在患者家中促进华法林教育克服了几个系统性障碍。虽然该干预与更好的短期华法林知识相关，但可能需要进行随访以优化其益处。药剂师广泛实施家庭华法林教育有可能为改善华法林治疗效果做出重大贡献。
