Best strategies for patient education about anticoagulation with warfarin: a systematic review.
BACKGROUND
Patient education is an essential component in quality management of the anticoagulated patient. Because it is time consuming for clinicians and overwhelming for patients, education of the anticoagulated patient is often neglected. We surveyed the medical literature in order to identify the best patient education strategies.


METHODS



METHODS
Two reviewers independently searched the MEDLINE and Google Scholar databases (last search March 2007) using the terms "warfarin" or "anticoagulation", and "patient education". The initial search identified 206 citations, A total of 166 citations were excluded because patients were of pediatric age (4), the article was not related to patient education (48), did not contain original data or inadequate program description (141), was focused solely on patient self-testing (1), was a duplicate citation (3), the article was judged otherwise irrelevant (44), or no abstract was available (25).


METHODS
Clinical setting, study design, group size, content source, time and personnel involved, educational strategy and domains, measures of knowledge retention.


RESULTS



RESULTS
A total of 32 articles were ultimately used for data extraction. Thirteen articles adequately described features of the educational strategy. Five programs used a nurse or pharmacist, 4 used a physician, and 2 studies used other personnel/vehicles (lay educators (1), videotapes (1)). The duration of the educational intervention ranged from 1 to 10 sessions. Patient group size most often averaged 3 to 5 patients but ranged from as low as 1 patient to as much as 11 patients. Although 12 articles offered information about education content, the wording and lack of detail in the description made it too difficult to accurately assign categories of education topics and to compare articles with one another. For the 17 articles that reported measures of patient knowledge, 5 of the 17 sites where the surveys were administered were located in anticoagulation clinics/centers. The number of questions ranged from as few as 4 to as many as 28, and questions were most often of multiple choice format. Three were self-administered, and 2 were completed over the telephone. Two reports described instruments along with formal testing of the validity and reliability of the instrument.


CONCLUSIONS
Published reports of patient education related to warfarin anticoagulation vary greatly in strategy, content, and patient testing. Prioritizing the educational domains, standardizing the educational content, and delivering the content more efficiently will be necessary to improve the quality of anticoagulation with warfarin.
Wofford
James L
JL
Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. jwofford@wfubmc.edu
Wells
Megan D
MD
Singh
Sonal
S
D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010347:Patient Care Planning; D010348:Patient Care Team; D010353:Patient Education as Topic / Q000592:standards*; D015397:Program Evaluation; D012648:Self Care; D014859:Warfarin / Q000008:administration & dosage* / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin