Poungkaew Autchariya, Tankumpuan Thitipong, Riangkam Chontira, Kongwatcharapong Junporn, Daekunthod Tassanee, Sriyayang Khachol, Krittayaphong Rungroj, Koirala Binu
Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
J Multidiscip Healthc. 2024 Sep 14;17:4455-4464. doi: 10.2147/JMDH.S472597. eCollection 2024.
Older people mostly found unable to adhere with warfarin treatment guidelines. The health service system is challenged in order to improve medication adherence in older population under limited health resources. The purpose of this study was to explore health systems factors on warfarin adherence in older population, particularly in resources constraint setting.
This study was a cross-sectional predictive study that enrolled older people who experienced atrial fibrillation (AF) and treated by warfarin, aged 60 years and over, and followed up at the warfarin clinic.
A total of 197 participants with the mean age of 72.03 years (SD = 8.84) was recruited. Almost of them (85.8%) reported adhered to warfarin prescription. More than a half (60.5%) were able to report their targeted INR. Participants who stayed with the family had 5.54 times (95% CI 1.79-19.33), took regular daily dose warfarin had 5.07 times (95% CI 1.05-24.49), perceived targeted INR had 2.94 times (95% CI 1.04-8.29), and received family support had 1.33 times (95% CI 1.11-1.60) increased odds of warfarin adherence than those who did not. Participants who perceived a barrier to taking medication had 0.93 times decreased odds of warfarin adherence than those who did not (95% CI 0.86-0.99).
Healthcare system should encourage family to support the older population with AF in order to increase warfarin adherence. Future research should develop intervention combining family support to promote warfarin adherence.
大多数老年人无法遵循华法林治疗指南。在卫生资源有限的情况下，卫生服务系统面临着提高老年人群药物依从性的挑战。本研究的目的是探讨卫生系统因素对老年人群华法林依从性的影响，特别是在资源受限的环境中。
本研究为横断面预测性研究，纳入年龄在60岁及以上、患有房颤（AF）且接受华法林治疗并在华法林诊所接受随访的老年人。
共招募了197名参与者，平均年龄为72.03岁（标准差=8.84）。其中几乎所有人（85.8%）报告遵循了华法林处方。超过一半（60.5%）的人能够报告其目标国际标准化比值（INR）。与家人同住的参与者华法林依从性的几率比未与家人同住的参与者高5.54倍（95%置信区间1.79-19.33），每天规律服用华法林的参与者高5.07倍（95%置信区间1.05-24.49），知晓目标INR的参与者高2.94倍（95%置信区间1.04-8.29），获得家庭支持的参与者高1.33倍（95%置信区间1.11-1.60）。认为服药存在障碍的参与者华法林依从性的几率比未这样认为的参与者低0.93倍（95%置信区间0.86-0.99）。
医疗保健系统应鼓励家庭支持患有房颤的老年人，以提高华法林依从性。未来的研究应开发结合家庭支持的干预措施，以促进华法林依从性。
