Effect Of A Designed Warfarin Based Education Program On Patients’ Knowledge And Anticoagulation Control Among Adult Outpatients Attending Clinics At Kenyatta National Hospital.

Abstract

Background: Warfarin is a widely used oral anticoagulant drug for the prevention of thrombosis associated with atrial fibrillation, deep vein thrombosis and pulmonary embolism. The drug has a narrow therapeutic index thereby necessitating frequent patients‘ assessment. Patients‘ knowledge on warfarin use promotes optimal anticoagulation, including adherence and control Study Objective: The main objective of this study was to evaluate the effect of a warfarin based patient education program on oral anticoagulation knowledge, adherence and control among adult outpatients attending anticoagulation clinics at Kenyatta National Hospital. Study Design and Participants: This was a pre-test/post-test single group quasi experimental study. A total of 45 patients aged ≥18 years and taking warfarin, were recruited by convenience sampling as they came for clinic appointments. They had to be attending the cardiothoracic, cardiac, deep vein thrombosis and hemato-oncology clinics at Kenyatta National Hospital. Methods: A pre-designed structured questionnaire was administered to the patients to obtain information about their knowledge and adherence to anticoagulation therapy. The patients‘ most recent International Normalized Ratio tests were also recorded for assessment of the level of anticoagulation control. Warfarin education program detailing the indications, precautions, side-effects and monitoring of the drug was then provided to the patient on a one to one basis. The patients were also given a warfarin education booklet for reference. Evaluation of the knowledge, adherence and level of anticoagulation control was done 30 days after providing the education intervention. The raw data was entered into Microsoft Access version 2010, cleaned and exported to IBM Statistical package for social sciences version 21.0 for analysis. Student t-test was used to compare the knowledge, adherence level and anticoagulation control pre and post intervention at 95% confidence level. P-value of ≤ 0.05 was considered significant. Results: Study participants had a mean age of 42.89±13.67 years with majority of them being female (86.7%) and married (66.7%). Only 26.7% of the participants had good knowledge (≥70%) before the intervention while 84.4% of them scored ≥70% at post-test. Middle aged participants had better anticoagulation knowledge before the intervention (p=0.04). However, none of the patient socio-demographic factors was statistically significantly associated with xv knowledge scores after the intervention. There was an improvement between the pre-test and post-test knowledge mean scores (p≤0.001). Adherence to anticoagulation therapy increased from a third to two-thirds after the intervention and this was statistically significantly associated with patients‘ occupation. There was a statistically significant difference in the mean adherence scores before and after the intervention (mean=6.29±1.590) and (mean= 7.38±1.029), t (45) = -3.811, respectively (p ≤ 0.001).Additionally, therapeutic anticoagulation control was maintained by 30% and 50% of the patients at pre and post-tests, respectively. Therapeutic anticoagulation control was maintained by a third and 50% of the patients at pre and post-tests, respectively. Conclusion: Provision of a warfarin based education program may help in improving patient knowledge and adherence in anticoagulation therapy Recommendation: A designed warfarin education program, consisting of one to one patient counseling and a warfarin education booklet should be provided to patients to boost their knowledge and adherence to anticoagulation