title: Adherence in outpatients taking warfarin and its effect on anticoagulation control in Jordan.
abstract: Background Medication adherence is an important element for the success of any therapeutic plan. The picture is more complicated with warfarin, due to its small therapeutic window and patients' needs to have effective anticoagulation control. Objective To measure warfarin-adherence, warfarin-knowledge and to assess the relationship between adherence and anticoagulation control. Setting Adult outpatients (≥18 years) taking warfarin at two medical sites in north of Jordan were invited to participate. Method This was a cross sectional study in which survey questionnaire that included demographic, clinical, warfarin related questions and Morisky Medication Adherence Scale (MMAS-8) was administered to patients in Arabic language. International normalization ratio (INR) readings were retrieved from patients' medical records. Main outcome measure MMAS-8 adherence scores and time within therapeutic range were calculated. Results More than half of study participants (54 %) were adherent (MMAS-8 = 8). The MMAS-8 adherence scores were significantly associated with warfarin-knowledge scores (Spearman's ρ = 0.291, p = 0.000). Adherent patients were more likely to have good anticoagulation control compared to non-adherent patients (MMAS-8 ≤ 7). Conclusion Adherence to warfarin therapy can have a substantial effect on anticoagulation control. Thus, healthcare practitioners should consider strategies to improve patient adherence to warfarin.
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan. mababneh@just.edu.jo.
authors.forename: Mera A
authors.initials: MA
authors.lastname: Ababneh
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
authors.forename: Sayer I
authors.initials: SI
authors.lastname: Al-Azzam
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
authors.forename: Karem H
authors.initials: KH
authors.lastname: Alzoubi
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
authors.forename: Abeer M
authors.initials: AM
authors.lastname: Rababa'h
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019934:International Normalized Ratio; D007597:Jordan; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D014859:Warfarin / Q000627:therapeutic use*; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Adherence; Anticoagulation control; Jordan; Knowledge; MMAS-8; Warfarin