Abstract
BackgroundOral anticoagulation therapy (OAT) is a challenge in general practice, especially for high-risk groups such as the elderly. Insufficient patient knowledge about safety-relevant aspects of OAT is considered to be one of the main reasons for complications. The research question addressed in this manuscript is whether a complex intervention that includes practice-based case management, self-management of OAT and additional patient and practice team education improves patient knowledge about anticoagulation therapy compared to a control group of patients receiving usual care (as a secondary objective of the Primary Care Management for Optimised Antithrombotic Treatment (PICANT) trial).MethodsThe cluster-randomised controlled PICANT trial was conducted in 52 general practices in Germany, between 2012 and 2015. Trial participants were patients with a long-term indication for oral anticoagulation. A questionnaire was used to assess knowledge at baseline, after 12, and after 24 months. The questionnaire consists of 13 items (with a range of 0 to 13 sum-score points) covering topics related to intervention. Differences in the development of patient knowledge between intervention and control groups compared to baseline were assessed for each follow-up by means of linear mixed-effects models.ResultsSeven hundred thirty-six patients were included at baseline, of whom 95.4% continued to participate after 12 months, and 89.3% after 24 months. The average age of patients was 73.5 years (SD 9.4), and they mainly suffered from atrial fibrillation (81.1%). Patients in the intervention and control groups had similar knowledge about oral anticoagulation at baseline (5.6 (SD 2.3) in both groups). After 12 months, the improvement in the level of knowledge (compared to baseline) was significantly larger in the intervention group than in the control group (0.78 (SD 2.5) vs. 0.04 (SD 2.3); p = 0.0009). After 24 months, the difference between both groups was still statistically significant (0.6 (SD 2.6) vs. -0.3 (SD 2.3); p = 0.0001).ConclusionSince this intervention was effective, it should be established in general practice as a means of improving patient knowledge about oral anticoagulation.Trial registrationCurrent controlled trials ISRCTN41847489; Date of registration: 13/04/2012
Highlights
Oral anticoagulation therapy (OAT) is a challenge in general practice, especially for high-risk groups such as the elderly
We present the results of the cluster-randomised controlled Primary Care Management for Optimised Antithrombotic Treatment study assessing whether patients with a long-term indication for oral anticoagulation knew more about OAT following a structured complex intervention
The need for education remains, even when vitamin K antagonists are replaced by direct oral anticoagulants
Summary
Oral anticoagulation therapy (OAT) is a challenge in general practice, especially for high-risk groups such as the elderly. The prevalence of patients receiving anticoagulants in Germany is high, with about 930,000 people taking coumarins daily [1]. Adequate oral anticoagulation management is a key challenge in the medical care of elderly patients in general practices [2]. In the general adult population in Germany, the 1-year prevalence of atrial fibrillation (AF), the most common indication for long-term oral anticoagulation [3], has recently been estimated at 2.3%, and it rises considerably with age [4]. The management of coumarin therapy is often challenging because the narrow therapeutic index (for patients with AF a target Internationalised Normalised Ratio (INR) of 2.0 to 3.0 is recommended) makes it difficult to achieve optimal doses of the medication, and food-drug interactions are common [7]. About 20% of hospitalisations in Europe as a result of acute stroke are related to atrial fibrillation [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
