Department of Nursing, Asan Medical Center, Seoul 05505, Korea.
Department of Nursing, Chung-Ang University, Seoul 06974, Korea.
Int J Environ Res Public Health. 2021 May 14;18(10):5214. doi: 10.3390/ijerph18105214.
Non-adherence is highlighted as one of the main contributors to the occurrence of adverse events and negative clinical outcomes in patients treated with warfarin. The aim was to examine knowledge on warfarin, medication belief, depression, and self-efficacy as factors influencing medication adherence for anticoagulation control. This was a cross-sectional study. The participants in this study were patients who visited an outpatient clinic of cardiovascular surgery to administer anticoagulants after mechanical valve replacement surgery at a tertiary hospital in Seoul. Responses of 154 participants on questionnaires were analyzed from 10 September to 26 December 2020. Multiple regression analyses were performed to assess the factors influencing medication adherence among the patients with anticoagulation control. Factors influencing medication adherence were consuming warfarin for 3 to 5 years, awareness of target prothrombin time international normalized ratio, knowledge of warfarin, and depression. Medication beliefs and self-efficacy had no significant influence on medication adherence. The most important factors associated with medication adherence in patients with mechanical heart valves were knowledge about warfarin and depression. In the control of oral anticoagulants that require continuous management, education and providing accurate guidance is more important than personal preferences. Clinical nurses should facilitate educational programs tailored to the characteristics of the patient, including their purpose and method of taking warfarin, specific diets, their knowledge on warfarin's interaction with other drugs, symptoms of adverse events, and self-management. In addition, healthcare providers should check whether warfarin therapy is being controlled by evaluating medication adherence and depression levels among patients.
不遵医嘱是导致华法林治疗患者发生不良事件和临床不良结局的主要因素之一。本研究旨在探讨华法林知识、药物信念、抑郁和自我效能感对抗凝控制药物依从性的影响。这是一项横断面研究。该研究的参与者是在首尔的一家三级医院接受机械心脏瓣膜置换术后到心血管外科门诊接受抗凝治疗的患者。2020 年 9 月 10 日至 12 月 26 日期间，对 154 名参与者的问卷回答进行了分析。采用多元回归分析评估影响抗凝控制患者药物依从性的因素。影响药物依从性的因素包括：服用华法林 3 至 5 年、知晓目标凝血酶原时间国际标准化比值、对华法林的了解以及抑郁。药物信念和自我效能感对药物依从性没有显著影响。影响机械心脏瓣膜患者药物依从性的最重要因素是对华法林的了解和抑郁。在需要持续管理的口服抗凝剂控制中，教育和提供准确的指导比个人偏好更重要。临床护士应根据患者的特点，包括他们服用华法林的目的和方法、特殊饮食、对华法林与其他药物相互作用的了解、不良反应症状以及自我管理等，为患者制定有针对性的教育计划。此外，医疗保健提供者应通过评估患者的药物依从性和抑郁水平来检查华法林治疗是否得到控制。
