Shilbayeh Sireen Abdul Rahim, Almutairi Wejdan Ali, Alyahya Sarah Ahmed, Alshammari Nouf Hayef, Shaheen Eiad, Adam Alya
Department of Pharmacy Practice,, Pharmacy College Princess Nourah bint Abdul Rahman University, Riyadh, 11671, P.O. Box 84428, Saudi Arabia.
Int J Clin Pharm. 2018 Feb;40(1):56-66. doi: 10.1007/s11096-017-0569-5. Epub 2017 Nov 30.
Background Although it can result in serious complications due to its narrow therapeutic index, warfarin is widely used in the treatment and prevention of thromboembolic disorders. However, patients' adherence and knowledge are determinants of therapeutic success. Objective We sought to validate instruments to provide a reliable means of identifying gaps in patient understanding and nonadherence to inform targeted pharmacists' interventions to improve these measures. Methods A cross-sectional survey was conducted. Patients' knowledge about warfarin was rated using an Arabic-language tool. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). The international normalized ratio (INR) control was quantified by the Rosendaal Method. Setting At the Security Forces hospital anticoagulant clinic (ACC), Riyadh. Main outcome measure Validity of a Knowledge and adherence tool. Results Totally, 101 patients completed the questionnaires. Interestingly, the knowledge tool demonstrated good internal consistency (total Cronbach's alpha = 0.75) and significant concurrent validity with adherence levels. Fifty-two patients were classified as having unsatisfactory knowledge. Deficiency in knowledge was most obvious with respect to the consequences of missing a dose and when to seek immediate medical attention. The MMAS-8 had moderate reliability (Cronbach's alpha = 0.65); however, its concurrent validity with good INR control was not demonstrated. Conclusions This study revealed high prevalence of nonadherence and poor knowledge in the population visiting the ACC. Given that available knowledge and adherence tools seemed to have little validity in predicting clinical outcomes, structured tools should be designed, considering progression in clinical outcomes with future pharmacists' interventions.
背景 尽管华法林因其治疗指数狭窄可能导致严重并发症，但它仍被广泛用于血栓栓塞性疾病的治疗和预防。然而，患者的依从性和知识水平是治疗成功的决定因素。目的 我们试图验证相关工具，以提供一种可靠的方法来识别患者理解方面的差距和不依从情况，从而为有针对性的药师干预提供依据，以改善这些指标。方法 进行了一项横断面调查。使用阿拉伯语工具对患者对华法林的知识进行评分。使用八项Morisky药物依从性量表（MMAS-8）评估药物依从性。通过Rosendaal方法量化国际标准化比值（INR）控制情况。地点 利雅得安全部队医院抗凝门诊（ACC）。主要结局指标 知识与依从性工具的有效性。结果 共有101名患者完成了问卷调查。有趣的是，知识工具显示出良好的内部一致性（总Cronbach's α = 0.75），并且与依从水平具有显著的同时效度。52名患者被归类为知识水平不达标。在漏服剂量的后果以及何时寻求紧急医疗关注方面，知识缺乏最为明显。MMAS-8具有中等可靠性（Cronbach's α = 0.65）；然而，未证明其与良好的INR控制具有同时效度。结论 本研究揭示了在ACC就诊人群中不依从和知识水平差的高患病率。鉴于现有的知识和依从性工具在预测临床结局方面似乎效度有限，应设计结构化工具，同时考虑未来药师干预对临床结局的影响。
