title: Upsetting the apple cart: a community anticoagulation clinic survey of life event factors that undermine safe therapy.
abstract: Anticoagulation therapy is a life-enhancing therapy for patients who are at risk for embolic events secondary to atrial fibrillation, valve replacement, and other comorbidities. Clinicians are motivated to decrease the amount of time that patients are either under- or over-anticoagulated, common conditions that decrease patient safety at either extreme. The primary purpose of this descriptive study was to examine the relationship between personal life event factors as measured by Norbeck's Life Events Questionnaire, core demographics such as age and income, and anticoagulation regulation. Although many factors affect anticoagulation therapy, the precise impact of life events, positive or negative, is unknown. The salient findings of this study (n = 202) showed a small, though statistically significant, inverse relationship (r = -0.184, P < .01) between negative life events and decreased time within therapeutic international normalized ratio. Total Life Event scores showed a statistically significant inverse relationship (r = -0.159, P < .05) to international normalized ratio time within therapeutic level. Lower income was inversely associated with higher negative Life Event scores (r = -0.192, P < .01). The findings demonstrate the need for strategies that address the potential impact of life events in conjunction with coexisting screening measures used in anticoagulation clinics. Implications for this study are limited by lack of methodology documenting concurrent social support factors and limitations of the research tool to reflect life event issues specific to outpatient seniors.
authors.affiliation: Dominican Hospital, Catholic Healthcare West, Santa Cruz, California, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Edmundson
authors.forename: Diane L
authors.initials: DL
authors.lastname: Stuenkel
authors.forename: Phyllis M
authors.initials: PM
authors.lastname: Connolly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D000925:Anticoagulants / Q000008:administration & dosage*; D002140:California; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D017751:Safety Management
chemical_list: D000925:Anticoagulants