Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial
| Autor: | Gregory Y.H. Lip, Danielle Clarkesmith, Helen M Pattison, Deirdre A. Lane |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Male
Health Knowledge Attitudes Practice medicine.medical_specialty Time Factors Science Culture Anxiety Medication Adherence law.invention Patient Education as Topic Quality of life Randomized controlled trial law Atrial Fibrillation Clinical endpoint medicine Humans International Normalized Ratio Stroke Aged Aged 80 and over Multidisciplinary Depression business.industry Warfarin Anticoagulants Atrial fibrillation Middle Aged medicine.disease Clinical trial Quality of Life Physical therapy Medicine Female Perception medicine.symptom business Research Article medicine.drug |
| Zdroj: | PLoS ONE, Vol 8, Iss 9, p e74037 (2013) PLoS ONE |
| ISSN: | 1932-6203 |
| Popis: | BackgroundStroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its treatment may contribute to the patient's willingness to adhere to recommendations.MethodA theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1-6 patients) utilising an "expert-patient" focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605) against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD) 72.0 (8.2), 67.4% men), or usual care (n=51, mean age (SD) 73.7 (8.1), 62.7% men), stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR); secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions.Main findingsIntervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035); at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44). Knowledge increased significantly across time (F (3, 47) = 6.4; pConclusionsA theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients' understanding of the necessity of warfarin and reducing their perception of treatment harm. Improving education provision for AF patients is essential to ensure efficacious and safe treatment. The trial is registered with Current Controlled Trials, ISRCTN93952605, and details are available at www.controlled-trials.com/ISRCTN93952605. |
| Databáze: | OpenAIRE |
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