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Effectiveness of a Nursing Intervention Module on Adherence, Knowledge, Quality of Life, and Complications Among
Janet Prameela Dsouza1, Jyothi Chakrabarty1, Padmakumar Ramachandran2
1Department of Medical-Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Insights
A nursing intervention module improved patient adherence to oral anticoagulation therapy, enhancing knowledge and quality of life while reducing complications. This study evaluated its effectiveness in managing cardiovascular disease patients on anticoagulants.
Area of Science:
- Cardiology
- Nursing
- Pharmacology
Background:
- Cardiovascular diseases cause significant global mortality, with oral anticoagulants like warfarin and acenocoumarol crucial for preventing thromboembolic disorders.
- Millions in India require oral anticoagulation therapy for conditions including rheumatic heart disease, atrial fibrillation, and deep vein thrombosis.
- The narrow therapeutic range of oral anticoagulants presents challenges in patient management.
Purpose of the Study:
- To evaluate the effectiveness of a nursing intervention module on therapy adherence, knowledge, quality of life, and complications in patients on oral anticoagulation.
- To identify factors influencing adherence and the risk of bleeding in this patient population.
Main Methods:
- A single-blind, single-center randomized controlled trial involving 320 patients on oral anticoagulation therapy.
- Patients were randomized into an intervention group (receiving a nursing intervention module) or a standard care group.
- Outcomes including knowledge, adherence, complications, and quality of life were assessed at baseline and follow-up.
Main Results:
- The nursing intervention module aims to improve patient safety through enhanced medication adherence and monitoring.
- It is expected to reduce thromboembolic and bleeding complications by addressing nonadherence behaviors.
- The study will assess the module's effectiveness in promoting adherence to oral anticoagulation therapy.
Conclusions:
- Effective patient adherence to medication and regular monitoring are vital for safety in oral anticoagulation therapy.
- The nursing intervention module is designed to improve adherence and patient outcomes.
- This study will provide insights into managing patients requiring long-term anticoagulation.
Background:
Cardiovascular diseases are one of the major causes of mortality at the global level. They account for approximately 17.9 million deaths per year. Warfarin and acenocoumarol are the commonly used oral anticoagulants to treat and prevent thromboembolic disorders in patients with cardiovascular diseases. In India, approximately 2-2.5 million patients with rheumatic heart disease are receiving oral anticoagulation therapy. Additionally, this therapy is provided for stroke prevention in the case of atrial fibrillation and the treatment of valvular heart disease, stroke, and deep vein thrombosis. As the therapeutic range of these drugs is narrow and is affected by many factors, their use is challenging. This study aims to evaluate the effectiveness of a nursing intervention module in terms of adherence to therapy, knowledge, quality of life, and complications among patients receiving oral anticoagulation therapy. Furthermore, this study will address factors that affect adherence and the risk for bleeding by using a randomized controlled trial design.
Methods:
This single-blind, single-center, randomized controlled trial will focus on adherence to oral anticoagulation therapy. A total of 320 patients who are on oral anticoagulation therapy will be randomized into blocks and allocated to either the intervention or standard care group. The intervention will comprise the use of a nursing intervention module that includes a booklet, log sheet, and decision aid on oral anticoagulation therapy adherence. Outcome measures, that is, knowledge regarding oral anticoagulation therapy, adherence, complications, and quality of life, will be assessed at the baseline and during follow-ups.
Discussion:
Patient safety can be best achieved through patients' adherence to medication dose and monitoring of blood test values. Thromboembolic and bleeding complications are likely to occur when either the patient does not adhere to the treatment or the therapeutic range of the international normalized ratio is not maintained. This study will assess the nonadherence behavior and the effectiveness of a nursing intervention module toward adherence behavior.
Trial Registration:
This research project is registered under the Clinical Trial Registry of India (CTRI/2019/06/019610).
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