Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 Feb 1;18(1):80.
doi: 10.1186/s12913-018-2874-7.

A multicenter, prospective study evaluating the impact of the clinical pharmacist-physician counselling on warfarin therapy management in Lebanon

Nermine S Choumane  1 , Diana N Malaeb  2 , Bassem Malaeb  3 , Souheil Hallit  4   5   6   7   8   9
Affiliations
Multicenter Study

A multicenter, prospective study evaluating the impact of the clinical pharmacist-physician counselling on warfarin therapy management in Lebanon

Nermine S Choumane et al. BMC Health Serv Res. .

Abstract

Background: Health care professionals (HCP) are known key elements of effective patient's counselling and education. For patients taking warfarin, education about the dose, side effects, and toxicity is clearly identified as a cornerstone of achieving improved health and quality of life. The study objective was to evaluate the patients' knowledge about warfarin and assess the impact of the health care professionals' counselling in enhancing patients' knowledge in achieving warfarin therapeutic outcomes.

Method: A six-month prospective multicentered study was conducted in three hospitals, enrolling 300 patients admitted to the cardiac care unit and internal medicine departments. Patients' warfarin knowledge and INR levels were assessed before and after the clinical pharmacist counselling. The main therapeutic outcome was the impact of the clinical pharmacist-physician counselling on improving patient's education and achieving therapeutic INR level.

Results: A higher mean knowledge about warfarin score was found after counselling as compared to before counselling (4.82 vs 13.2; p < 0.001). Likewise, the drug dose (1.05 vs 1.88), drug toxicity (0.41 vs 1.92), drug-drug and food-drug interactions (0.02 vs 1.89), therapeutic INR and general drug knowledge scores (2.66 vs 4.68) were significantly higher after as compared to before counselling (p < 0.001 for all variables). The percentages of patients who achieved therapeutic INR levels pre/post counselling was 37.2% and 74.4% respectively (p < 0.001).

Conclusion: Based on the study findings, HCP play a major role in enhancing patients' knowledge about the factors that affect warfarin therapeutic outcomes. This study highlights the need to establish and develop strategies for appropriate warfarin utilization in Lebanon.

Keywords: Clinical pharmacist; Counselling; Patient knowledge; Therapeutic INR; Warfarin.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The ethics approval was obtained from the Institutional Review Board of the School of Pharmacy at the Lebanese International University. The study objective was explained to the patient prior to the interview, and a written consent was obtained if the patient verbally agreed to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of patient’s randomization and follow up
Fig. 2
Fig. 2
Comparison of the standard error and mean warfarin knowledge questionnaire score before and after counseling
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Barcellona D, Contu P, Marongiu F. Patient education and oral anticoagulant therapy. Haematologica. 2002;87(10):1081–1086. - PubMed
    1. Khudair IF, Hanssens YI. Evaluation of patients’ knowledge on warfarin in outpatient anticoagulation clinics in a teaching hospital in Qatar. Saudi Med J. 2010;31(6):672–677. - PubMed
    1. Wysowski DK, Nourjah P, Swartz L. Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action. Arch Intern Med. 2007;167(13):1414–1419. doi: 10.1001/archinte.167.13.1414. - DOI - PubMed
    1. Yahaya A, et al. Factors associated with warfarin therapy knowledge and anticoagulation control among patients attending a warfarin clinic in Malaysia. J Clin Diagn Res. 2009;3(4):1663–1670.
    1. Hasan SS, et al. Factors affecting warfarin-related knowledge and INR control of patients attending physician- and pharmacist-managed anticoagulation clinics. J Pharm Pract. 2011;24(5):485–493. doi: 10.1177/0897190011415684. - DOI - PubMed

Publication types