title: An Education Program for Patient Self-Management of Warfarin.
abstract: BACKGROUND
  Although improved anticoagulation therapy outcomes have been demonstrated in clinical trials evaluating warfarin patient self-management (PSM) programs, these studies did not provide detailed information regarding PSM program development and patient training.
  
  
  OBJECTIVE
  To evaluate the feasibility of and methods for developing and administering an education program to support a novel pilot warfarin PSM program.
  
  
  METHODS
  Patients receiving warfarin for atrial fibrillation were recruited to participate in a prospective, intervention-only, open-label pilot PSM program that released venipuncture international normalized ratio results to patients via a secure, online Web site. To support the pilot, a warfarin PSM education program with a dosing algorithm was developed and delivered to patients during a two-hour classroom session.
  
  
  METHODS
  A comparison of participants' PSM competency test scores before and after attending the PSM program.
  
  
  RESULTS
  Forty-four patients attended the education program. The mean age of participants was 71 years and 50% were women. Patients declining study participation were older (p = 0.003) and had a greater burden of chronic disease (p = 0.005) than participants. Following PSM training, the mean competency score improved from 55.8% to 88.8% (p < 0.001), and the proportion achieving a passing score increased from 34.9% to 95.3% (p < 0.001). In the poststudy survey, 100% of responders perceived that PSM training prepared them to self-manage warfarin, and 92.9% of responders were comfortable changing warfarin doses on their own.
  
  
  CONCLUSIONS
  Developing and administering a warfarin PSM education program for patients with atrial fibrillation was feasible. Improvement in PSM competency and high levels of self-reported comfort with warfarin PSM were identified.
authors.affiliation: Clinical Pharmacy Specialist with the Clinical Pharmacy Anticoagulation and Anemia Service for Kaiser Permanente Colorado in Aurora. kathleen.m.jenner@kp.org.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Jenner
authors.affiliation: Clinical Pharmacy Specialist with the Clinical Pharmacy Anticoagulation and Anemia Service for Kaiser Permanente Colorado in Aurora. brandon.x.simmons@kp.org.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Simmons
authors.affiliation: Clinical Pharmacy Research Scientist with the Clinical Pharmacy Research Department for Kaiser Permanente Colorado in Aurora. tom.delate@kp.org.
authors.forename: Thomas
authors.initials: T
authors.lastname: Delate
authors.affiliation: Supervisor and Clinical Pharmacy Specialist with the Clinical Pharmacy Anticoagulation and Anemia Service for Kaiser Permanente Colorado in Aurora. nathan.clark@kp.org.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Clark
authors.affiliation: Senior Project Manager with the Clinical Pharmacy Research Department for Kaiser Permanente Colorado in Aurora. deanna.kurz@kp.org.
authors.forename: Deanna
authors.initials: D
authors.lastname: Kurz
authors.affiliation: Clinical Professor and Vice Chair in the Department of Pharmacotherapy and Assistant Dean for Clinical Affairs at the University of Utah College of Pharmacy in Salt Lake City. dan.witt@pharm.utah.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Witt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D012648:Self Care / Q000379:methods*; D014859:Warfarin / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin