Patient attitudinal and behavioral factors associated with warfarin non-adherence at outpatient anticoagulation clinics.
BACKGROUND
Warfarin is an anticoagulant effective in preventing stroke, but it has a narrow therapeutic range requiring optimal adherence to achieve the most favorable effects.


OBJECTIVE
The goal of this study was to examine specific patient factors that might help explain warfarin non-adherence at outpatient anticoagulation clinics.


METHODS
In a prospective cohort study of 156 adults, we utilized logistic regression analyses to examine the relationship between the five Treatment Prognostics scales from the Millon Behavioral Medicine Diagnostic (MBMD), as well as three additional MBMD scales (Depression, Future Pessimism, and Social Isolation), and daily warfarin non-adherence assessed using electronic medication event monitoring systems caps over a median of 139 days.


RESULTS
Four of the five Treatment Prognostic scales and greater social isolation were associated with warfarin non-adherence. When controlling for pertinent demographic and medical variables, the Information Discomfort scale remained significantly associated with warfarin non-adherence over time.


CONCLUSIONS
Although several factors were related to warfarin non-adherence, patients reporting a lack of receptivity to details regarding their medical illness seemed most at risk for warfarin non-adherence. This information might aid in the development of interventions to enhance warfarin adherence and perhaps reduce adverse medical events.
Cruess
Dean G
DG
Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020, USA. Dean.Cruess@uconn.edu
Localio
A Russell
AR
Platt
Alec B
AB
Brensinger
Colleen M
CM
Christie
Jason D
JD
Gross
Robert
R
Parker
Catherine S
CS
Price
Maureen
M
Metlay
Joshua P
JP
Cohen
Abigail
A
Newcomb
Craig W
CW
Strom
Brian L
BL
Kimmel
Stephen E
SE
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D000925:Anticoagulants / Q000627:therapeutic use*; D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D006801:Humans; D055809:Illness Behavior; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008509:Medication Systems; D008875:Middle Aged; D010556:Personality Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012647:Self-Assessment; D014859:Warfarin / Q000627:therapeutic use*; D016903:Drug Monitoring
D000925:Anticoagulants; D014859:Warfarin