JRSM >
Volume 96, Number 11 >
Pp. 572
1 Medical School and Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
e-mail: H.A.Wynne{at}nci.ac.uk
The paper by Dr Nadar and co-workers (April 2003 JRSM1) pointed out gaps in knowledge about antithrombotic therapy of anticoagulated patients from ethnic minorities in Birmingham. It also indicated that being over 61 years is associated with a low knowledge score. Attempts are made in our monitoring service to inform patients about their warfarin therapy, but only by providing new patients with written information and continuing opportunities to have their questions addressed.
We set out to determine the satisfaction of anticoagulated patients with
the information with which they had been provided and whether their level of
knowledge was influenced by age, length of treatment and indication for
warfarin therapy. 57 consecutive patients, 26 under 65 years and 31 of 65
years and over, all white European, attending the anticoagulant clinic at the
Royal Victoria Infirmary, Newcastle upon Tyne, consented to complete the study
questionnaire, administered by HL who is not a member of the clinic staff. The
study had Newcastle upon Tyne Joint Ethics Committee approval. All 57 patients
reported having received adequate information about warfarin. 26 (84%)
patients of 65 years and over had no concerns about bleeding compared with 12
(46%) under 65 years. Only 8 (26%) of those of 65 years and over knew about
the potential of antibiotics to increase the international normalized ratio
(INR), and 11 (35%) were aware of alcohol's potential to increase it; none
knew that green vegetables could reduce it. This compared with, for those
under 65 years, 12 (46%) knowing of the interaction with antibiotics
(P<0.01, risk ratio (rr) 1.51, 95% CI 1.15-1.98), 23 (88%) of the
interaction with alcohol (P<0.0001; rr 2.51; 95% CI 1.94-3.36),
and 3 (12%) of the interaction with green vegetables (
2 for
trend in mean score, P<0.0001). It was only for potential
interactions between warfarin and antibiotics that knowledge was better in
patients anticoagulated for more than six months than in those anticoagulated
for less than this time (P<0.0001; rr 0.48; 95% CI 0.32-0.72). The
indication for warfarin had no apparent influence upon response.
Although as in Birmingham most patients expressed satisfaction with the information they had received, there are gaps in their knowledge. We support the call of Nadar and co-workers for more investment in patient education. Further investigation to determine the most effective means of informing patients about anticoagulation, with emphasis on high-risk subgroups which include not only ethnic minorities but also older people, and the effect of these interventions upon outcomes of therapy, is required.
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