Impact of an electronic medium delivery of warfarin education in a low income, minority outpatient population: A pilot intervention study

Krista Heinrich, Katherine Sanchez, Cecilia Hui, Kiara Talabi, Marlena Perry, Huanying Qin, Hoa Nguyen, Amulya Tatachar

Research output: Contribution to journalArticle

Abstract

Background: Warfarin is classified as a high-alert medication for ambulatory healthcare and safe guards for high-alert medications are necessary, including the practice of mandatory patient education. The high cost of hospitalizations related to adverse events combined with the average bleeding event rate of 7-8% in spite of routine patient education, suggests the importance of new approaches to standardized health education on warfarin. We sought to evaluate the impact of a warfarin educational video using an electronic tablet on patient knowledge and to determine patients' satisfaction with the use of an electronic tablet for educational purposes in outpatient clinics serving a low income, minority population. Methods: A warfarin educational video delivered on an electronic tablet (iPad) was delivered at two pharmacist-managed anticoagulation clinics to uninsured patients whose annual income is equal or less than two hundred percent below the poverty level were offered. Patients (n = 18) completed a pre-video and post-video knowledge test on warfarin before and after viewing the warfarin educational video on an electronic tablet and a follow-up test to measure the retention of knowledge and a patient satisfaction survey at 60 days. The primary outcome was change in knowledge test scores. Other outcome measures included adherence rates, adverse events, time in therapeutic INR range, and patient-reported satisfaction scores. Results: The majority of patients were uninsured men taking warfarin for atrial fibrillation (n = 5). The median scores at post-video knowledge test and follow-up knowledge test were significantly higher than that for the pre-knowledge test (12 (11-12) vs. 10(8-11), p < 0.001). The study group had a 'time in therapeutic INR' range of 56.3%, a rate of adverse events of 24.5%, and a self-reported adherence rate to warfarin of 94.1%. The majority of patients also had positive responses to the patient satisfaction survey. Conclusions: Patient education delivered via iPad to facilitate knowledge of medication can serve as a useful tool for educating patients about warfarin and warfarin therapy. Use of an electronic medium may be a unique way to provide standard medication education to patients. Trial registration: The study was retrospectively registered with: NCT03650777; 9/18/18.

Original languageEnglish
Article number1050
JournalBMC Public Health
Volume19
Issue number1
DOIs
StatePublished - 5 Aug 2019

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Warfarin
Outpatients
Education
Population
Patient Education
Patient Satisfaction
Tablets
International Normalized Ratio
Poverty
Ambulatory Care Facilities
Health Education
Pharmacists
Atrial Fibrillation
Hospitalization
Therapeutics
Outcome Assessment (Health Care)
Hemorrhage
Delivery of Health Care
Costs and Cost Analysis

Keywords

  • Education
  • Health literacy
  • Primary care
  • Technology
  • Warfarin

Cite this

Heinrich, Krista ; Sanchez, Katherine ; Hui, Cecilia ; Talabi, Kiara ; Perry, Marlena ; Qin, Huanying ; Nguyen, Hoa ; Tatachar, Amulya. / Impact of an electronic medium delivery of warfarin education in a low income, minority outpatient population : A pilot intervention study. In: BMC Public Health. 2019 ; Vol. 19, No. 1.
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abstract = "Background: Warfarin is classified as a high-alert medication for ambulatory healthcare and safe guards for high-alert medications are necessary, including the practice of mandatory patient education. The high cost of hospitalizations related to adverse events combined with the average bleeding event rate of 7-8{\%} in spite of routine patient education, suggests the importance of new approaches to standardized health education on warfarin. We sought to evaluate the impact of a warfarin educational video using an electronic tablet on patient knowledge and to determine patients' satisfaction with the use of an electronic tablet for educational purposes in outpatient clinics serving a low income, minority population. Methods: A warfarin educational video delivered on an electronic tablet (iPad) was delivered at two pharmacist-managed anticoagulation clinics to uninsured patients whose annual income is equal or less than two hundred percent below the poverty level were offered. Patients (n = 18) completed a pre-video and post-video knowledge test on warfarin before and after viewing the warfarin educational video on an electronic tablet and a follow-up test to measure the retention of knowledge and a patient satisfaction survey at 60 days. The primary outcome was change in knowledge test scores. Other outcome measures included adherence rates, adverse events, time in therapeutic INR range, and patient-reported satisfaction scores. Results: The majority of patients were uninsured men taking warfarin for atrial fibrillation (n = 5). The median scores at post-video knowledge test and follow-up knowledge test were significantly higher than that for the pre-knowledge test (12 (11-12) vs. 10(8-11), p < 0.001). The study group had a 'time in therapeutic INR' range of 56.3{\%}, a rate of adverse events of 24.5{\%}, and a self-reported adherence rate to warfarin of 94.1{\%}. The majority of patients also had positive responses to the patient satisfaction survey. Conclusions: Patient education delivered via iPad to facilitate knowledge of medication can serve as a useful tool for educating patients about warfarin and warfarin therapy. Use of an electronic medium may be a unique way to provide standard medication education to patients. Trial registration: The study was retrospectively registered with: NCT03650777; 9/18/18.",
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Impact of an electronic medium delivery of warfarin education in a low income, minority outpatient population : A pilot intervention study. / Heinrich, Krista; Sanchez, Katherine; Hui, Cecilia; Talabi, Kiara; Perry, Marlena; Qin, Huanying; Nguyen, Hoa; Tatachar, Amulya.

In: BMC Public Health, Vol. 19, No. 1, 1050, 05.08.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of an electronic medium delivery of warfarin education in a low income, minority outpatient population

T2 - A pilot intervention study

AU - Heinrich, Krista

AU - Sanchez, Katherine

AU - Hui, Cecilia

AU - Talabi, Kiara

AU - Perry, Marlena

AU - Qin, Huanying

AU - Nguyen, Hoa

AU - Tatachar, Amulya

PY - 2019/8/5

Y1 - 2019/8/5

N2 - Background: Warfarin is classified as a high-alert medication for ambulatory healthcare and safe guards for high-alert medications are necessary, including the practice of mandatory patient education. The high cost of hospitalizations related to adverse events combined with the average bleeding event rate of 7-8% in spite of routine patient education, suggests the importance of new approaches to standardized health education on warfarin. We sought to evaluate the impact of a warfarin educational video using an electronic tablet on patient knowledge and to determine patients' satisfaction with the use of an electronic tablet for educational purposes in outpatient clinics serving a low income, minority population. Methods: A warfarin educational video delivered on an electronic tablet (iPad) was delivered at two pharmacist-managed anticoagulation clinics to uninsured patients whose annual income is equal or less than two hundred percent below the poverty level were offered. Patients (n = 18) completed a pre-video and post-video knowledge test on warfarin before and after viewing the warfarin educational video on an electronic tablet and a follow-up test to measure the retention of knowledge and a patient satisfaction survey at 60 days. The primary outcome was change in knowledge test scores. Other outcome measures included adherence rates, adverse events, time in therapeutic INR range, and patient-reported satisfaction scores. Results: The majority of patients were uninsured men taking warfarin for atrial fibrillation (n = 5). The median scores at post-video knowledge test and follow-up knowledge test were significantly higher than that for the pre-knowledge test (12 (11-12) vs. 10(8-11), p < 0.001). The study group had a 'time in therapeutic INR' range of 56.3%, a rate of adverse events of 24.5%, and a self-reported adherence rate to warfarin of 94.1%. The majority of patients also had positive responses to the patient satisfaction survey. Conclusions: Patient education delivered via iPad to facilitate knowledge of medication can serve as a useful tool for educating patients about warfarin and warfarin therapy. Use of an electronic medium may be a unique way to provide standard medication education to patients. Trial registration: The study was retrospectively registered with: NCT03650777; 9/18/18.

AB - Background: Warfarin is classified as a high-alert medication for ambulatory healthcare and safe guards for high-alert medications are necessary, including the practice of mandatory patient education. The high cost of hospitalizations related to adverse events combined with the average bleeding event rate of 7-8% in spite of routine patient education, suggests the importance of new approaches to standardized health education on warfarin. We sought to evaluate the impact of a warfarin educational video using an electronic tablet on patient knowledge and to determine patients' satisfaction with the use of an electronic tablet for educational purposes in outpatient clinics serving a low income, minority population. Methods: A warfarin educational video delivered on an electronic tablet (iPad) was delivered at two pharmacist-managed anticoagulation clinics to uninsured patients whose annual income is equal or less than two hundred percent below the poverty level were offered. Patients (n = 18) completed a pre-video and post-video knowledge test on warfarin before and after viewing the warfarin educational video on an electronic tablet and a follow-up test to measure the retention of knowledge and a patient satisfaction survey at 60 days. The primary outcome was change in knowledge test scores. Other outcome measures included adherence rates, adverse events, time in therapeutic INR range, and patient-reported satisfaction scores. Results: The majority of patients were uninsured men taking warfarin for atrial fibrillation (n = 5). The median scores at post-video knowledge test and follow-up knowledge test were significantly higher than that for the pre-knowledge test (12 (11-12) vs. 10(8-11), p < 0.001). The study group had a 'time in therapeutic INR' range of 56.3%, a rate of adverse events of 24.5%, and a self-reported adherence rate to warfarin of 94.1%. The majority of patients also had positive responses to the patient satisfaction survey. Conclusions: Patient education delivered via iPad to facilitate knowledge of medication can serve as a useful tool for educating patients about warfarin and warfarin therapy. Use of an electronic medium may be a unique way to provide standard medication education to patients. Trial registration: The study was retrospectively registered with: NCT03650777; 9/18/18.

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KW - Health literacy

KW - Primary care

KW - Technology

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