Research Paper on "Interventions on Anticoagulation Patients Taking Warfarin With Education"

Research Paper 7 pages (4017 words) Sources: 7

[EXCERPT] . . . .

Patient-physician interaction usually marks the foremost step in the direction of reconnection. Thus, it is vital that providers pay attention to their patients' concerns, offer emotional support and healing, as well as promote the relationship, on the whole. This particular element of a therapeutic bond is not easy to define, but may be found, without much doubt, at the core of truly therapeutic relations. Also, quality care delivery's foundation is this healing facet (Travaline, Ruchinskas&D'Alonzo, 2005).

2.1.3 Health Belief Model (HBM)

HBM, formulated during the 50s, is certainly the most prevalent model employed in health promotion and education. The purpose of this model was to explain the reason behind the poor success of American Public Health Service-offered medical screening initiatives, especially for tuberculosis. HBM's initial primary concept was that health activities are governed by people's views or beliefs regarding a disease, as well as strategies available for reducing its occurrence. Perceived seriousness, benefits, barriers, and susceptibility are the model's key constructs. All of these perceptions (combined or separately) can help account for health behavior. The HBM has had other constructs -- self-efficacy, indications to action, and motivating factors -- included more recently (Chapter 4 Health Belief Model, n.d.).

3. Methodology

3.1. Research Design

TREAT denotes a randomized control TRial of a warfarin Educational program on INR control, AF and OAT knowledge, and Treatment outcome of patients[ISRCTN93952605]) against routine care among patients with AF, who have freshly been prescribed warfarin as part of their OAT.

The fundamental research question explores the impacts of an exhaustive educational program on INR control of patients within therapeutic limits (i.e., 2.0-3.0) in comparison to usual care patients. The educational program's influence on patient views and knowledge regarding AF, and attitude towards OAT will be determined by secondary endpoints. Moreover, the association of INR control with occurrence of minor and major bleeding, thrombo embolism and stroke in comparison to routine care patients will be studied. For an investigation of these endpoints, the TREAT randomized trial will establish whether any gaps exist between the control group (i.e., routine care group) and the group under study, at baseline, as well as30 days, 60 days, half a year, and one year after completion of intervention. Patients' subgroup analysis, (through variables likesocio-demographic information, sex and age), will establish whether information outcomes are connected to other elements like participating patients' gender or age. Lastly, an evaluation of healthcare utilization will be performed for ascertaining costs incurred in the exhaustive educational program in comparison to routine care, for the purpose of finding out whether large-scale implementation of the program, as an element of routine care, will be cost-efficient or not (Smith et al., 2010; Clarkesmith et al., 2013).

3.2. Sampling

Primary endpoint power was computed on the basis of information, from a secondary study, of TTR time from ACTIVE-W trial. The assumption in power calculation is that routine care patients are characterized by 58% mean TTR (standard deviation=7.5). Sample size for the knowledge improvement (post-intervention) secondary endpoint was derived from Lowthian's 2009 research. The cardiac facility has approximately 365 patients with OAT-symptoms associated with their corresponding cardiovascular problems. A study with 100 participants (i.e. sample size=100, with 20% incomplete/non-submitted questionnaires) has minimum 80% power of detecting a knowledge increase of 18.5% in regard toAF and influencers of INR control, from baseline to follow-up after a year (Smith et al., 2010).

3.3. Data Collection

A- Form for procuring personal participant information. This information is categorized into 1) demographic information such as gender, age, education level, occupation, marital status, income, residential info, number of kids and b) specific medical variables such as diagnosis/operation, over-the-counter drugs used, debilitating ailments suffered, etc.

B- Questionnaire for assessing pre/post warfarin-related knowledge. This questionnaire is separated into two key divisions: the first evaluates the patients' warfarin-related knowledge and comprises questions pertaining to symptoms, side effects, action, patient and pharmacokinetic measures to be taken for side-effects prevention, and lab tests which must be regularly checked and evaluated. The second deals with symptoms and indications of warfarin's side effects (Abd El-Naby et al., 2014).

3.4 Measurement of Patient Satisfaction and Quality of Life

The amount of time a patient spends within INR's therapeutic range (i.e., 2.0-3.0) is used as a measure of patient satisfaction. All participants in the study (both usual care and intervention and groups) will have to undergo INR testing, at the outpatient section of the anticoagulant clinic, via capillary blood sample. INR visit frequency will be determined by the clinic. All INR outcomes right from baseline through the 1-year follow-up testing will be documented. Linear interpolation method will be applied for calculation of the amount of time all individual patients spend within therapeutic range of 2.0-3.0; information from 1 month through 12 months will be used (for enabling achievement of accurate warfarin dose in the first month) (Kirsch, 2011; Smith et al., 2010).

Indicators of QOL are; (1) patient awareness [knowledge decrease/increase/constancy will be assessed through score change], (2) medication-related attitudes (3) illness representations and (4) depression and anxiety. The association of frequency of major and minor bleeding, stroke, thromboembolism (assuming the trial can't identify such differences) and INR testing frequency with INR control will be examined by means of ancillary analyses. The amount of thromboembolic events, strokes, and bleeding will be ascertained from the hospital's computerized records of clinical information (Clarkesmith et al., 2013; Phillips, 2010).

3.5. Ethics Consideration

The relevant research committee was approached for obtaining permission to carry out this study. All potential participants were, during an initial interview, made aware of the study's nature, purpose and benefits. Participants were also informed of the voluntary nature of participation, as well as participant anonymity and confidentiality via data coding. All individuals who were willing to be a part of the research project were given a written form of consent, which was collected prior to study commencement (Abd El-Naby et al., 2014).

3.6. Analysis

Data analysis will be carried out bearing in mind that the purpose is to treat. Analyses stratification will be based on center. There will be comparisons made with secondary and primary outcome measures at each time-point for identifying long- and short-term intervention impacts. Weighted mean will be applied in case of continuous variables (like modifications in disease perception survey or alteration in duration spent in therapeutic INR range). Owing to the sample's randomized nature, baseline differences will not be anticipated among groups (Smith et al., 2010).

Self-Regulation Theory Model

The study hopes to observe improvements in patients taking warfarin and that more controlled INR can be achieved. In line with the underlying theory (The self-regulation theory), the studypostulates that adherence is associated with sturdier perceptions of obligation for treatment and lesser concerns regarding adverse consequences.Anticoagulation clinics as well as home INR monitoring tend to enhance anticoagulation outcomes and control. Patients who have their warfarin administration monitored within anticoagulation clinics show lower levels of hostile events and improved level of anticoagulation in range. Monitoring of home INR also seems to be beneficial. Moreover, adherence to warfarin clearly affects anticoagulation control levels and the possibility of maintaining patients taking warfarin. Even at the modest degree of poor compliance to warfarin significantly affected poor anticoagulation control within thestudy (Ha & Longnecker, 2010).

Patient-Provider Communication Theory

Educating patients about both risks and benefits of anticoagulation is essential and ensures that patients are aware of: the way to take warfarin, warfarin can affect other medications, and appreciate the significance of consistent monitoring. Moreover, evidence indicates that even when patients comply with therapy, both dose and schedule of what patients actually take mayvary from the approved regimen; this "discordant care" canarise from lapses in communication between patient and physician. Patients who have limited health awareness did not show significant differences from those who had adequate health literacy with regard to the time in therapeutic INR range. Confining the analyses to the group of patients with INRs drawn did not considerably change the results (Fang, Machtinger, Wang & Schillinger, 2006).

Health Belief Model (HBM)

Patients learn through the health-belief model that deals with the patients' concerns such assymptoms and experience. The interdisciplinary approach developed through participation including patients' feedback using culturally suitable material aimed at improving outcomes, reducing barriers and health costs, and increasing compliance (Hui, 2010). The model showed the impact of patients'beliefs in their health behaviors.

3.7. Discussion

Roy's adaptation model, applied in the study, has the following strengths: assessment convenience in relevant and significant nursing programs that assisted patient flow via contextual, residual, and focal stimuli. Further, patient adaptation could be clearly seen through teaching by means of video and booklet; some of the patients preferred learning by watching a video, while others favoured booklet over video. Coping skills of patients were studied via their favoured learning mode (Abd El-Naby et al., 2014).

The adaptation model displays the following weaknesses: the four adaptation modes, all of which were regarded as processes; therefore, when speedy decision-making is necessitated, they may… READ MORE

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