It is reported that the development of cardiovascular disease is increasing in United States and almost 610,00 new cases of strokes is reported and almost 185000 individual developed strokes for the second time which indicated that the reoccurrence of the stroke incidence is one of the major issues which needs to be resolved through proper public health intervention (Boehme et al., 2017). The development of stroke is one of the leading causes of death in the United States which is common among the disabled adults. The development of stroke results in long-term disability and there are almost 7 million stroke survivors residing in the United States and 25% of the patients is found to recover from first stroke within the last 5years. The report also highlights that almost 87% of the individuals suffers from ischemic strokes by blocking the blood flow in to the brain. The long-term development of the stroke condition negatively impacts the health of the population which includes fatigueness, paralysis, depression, increased treatment cost and reduce quality of life (Ramphul et al., 2021). The patients are provided with anticoagulant therapy as it helps in reducing the blood clotting but there exists difficulty in long-term adherence towards the drugs which increases the incidence of reoccurrence of stroke (Patel et al., 2021). The following paper will discuss about the importance of patient educational intervention for increasing the patient’s adherence towards anticoagulant drugs.
The patient faces difficulty in maintaining a long-term adherence towards the consumption of anti-coagulant drugs. The main reasons which increase the chance of non-adherence includes lack of proper medication, lack of proper understanding about the drugs, increase risk of side effect, lack of knowledge and ability to determine the importance of medication adherence and fear cost of treatment (Hawking et al., 2020). The patient’s certainty is predisposed by lack of appropriate co-morbidities and deprived information in considering the disorder of atrial fibrillation. Hence, a proper self-assessment and self-management plans must be provided to the patient which will help in lowering the re-occurrence of stroke. The cost of providing health education in United State will be $100 and a proper monitoring of the patient’s condition needs to be done for reducing the long-term cost of treatment. The most common contradictions to anticoagulant include uncontrolled hypertension, frequent falls or blackouts and inability to comply with the treatment process (Oliveira-Kumakura et al., 2019). The patient must be provided with proper education about the contraindications, thrombocytopenia and hypersensivity. It is also stated that the stroke recurrence rate of stroke is controversial and it is reported that the rate is found to increase from 7.0% to 20.6% in the first year and that of 16.2% to 35.3% in the next five years and finally the rate is found to increase from 14% to 51.3% in next 10years after the initial period of stroke development.
Stahmeyer et al., (2019) performed a study for determining the frequency and timing of recurrent stroke. The study highlighted that stroke is one of the major causes of death which increases the risk of disability. The risk factors which increased the risk of developing stroke includes diabetes, hypertension and metabolic disorders. The result of the study highlighted that in the year 2010/2011 the incidence rate was 292 per 100000-person year and the standardized prevalence was 336 per 100000 per persons. The risk of occurrence was 3.4% in 90%, 1.2% in 30days, 7.4% in 1year and 19.4% in 5years. The reoccurrence of stroke also increased the rate from 6.8% to 45%. The study also stated that the patients must be provided with proper treatment in order to lower the stroke unit.
PICO- “Does implementation of the patient education, monitoring of the condition helps in lowering the risk of stroke?”
Population- Stroke patient
Intervention- Patient education
Comparison- Usual care
Outcome- Long-term adherence
The search strategies used for collecting papers are- “Stroke”, “Anticoagulant”, “Patient education”, “Intervention”, “Fear of reoccurrence”, “mortality”. The Boolean operators AND and OR are used for collecting articles which includes- “Stroke AND Cardiovascular disease”, “Stroke AND United States”, “Anticoagulant OR Warfin”, “Usual Care AND Patient education”, “Patient education AND Anticoagulant drug”, “Prevention AND Patient education”, “Recurrent Ischemic Stroke AND Anticoagulant drug”, “Interview OR Anti-coagulant recommendation”. The Boolean operations AND and OR are used for collecting relevant articles from the search database.
The search databases which were used for collecting relevant articles includes- “NCBI”, “Google Scholar”, “PubMed”, “Medline”, “CINAHL”. The papers which were published between the year 2016 to 2022. The articles which were published in English was included in the study. A total number of 7 papers are included in the study.
Pandya & Bajorek (2017) performed a study for determining the role of oral anticoagulants and extensive consideration from the perspective of clinicians. The study highlighted that the effectiveness and safety of using anticoagulants is dependent upon the patient’s ability to manage the patient’s condition and taking drugs in the right amount and at the right time which will help in lowering the chance of developing complications. The study also highlighted that it is the responsibility of the patient to manage high risk medicines by taking challenges in managing complex situations and for that effective patient education is highly essential. The result of the study highlighted the fact that it is important to consider five interacting dimensions for providing proper patient education related to long-term adherence of anticoagulant therapy among the patients suffering from chronic disorders such as stroke. The factors which need to be considered include therapy related factor, condition related factor, patient related factor, socio-economic factor and health factor (Bennaghmouch et ., 2019). The study also highlighted that these factors negatively affect the patient’s day to day life which includes regular therapeutic drug monitoring system, dietary consideration and dose monitoring system. It is also highlighted that the patient who consumes warfarin is reported to have long-term non adherence to a drug. The study also highlighted that the non-adherence towards anticoagulant medication includes patient perception and knowledge about the purpose of anticoagulation, lack of proper understanding about the risk and benefit of the treatment, excessive expectation from care or healthcare providers and socioeconomic status. The result of the study clearly determined the fact that a proper patient education must be provided to the cardiovascular disease patients in order to reduce the prevalence of stroke by lowering the barrier such as recommending the patient. The patient education mast comprises of information about regular monitoring of the patient’s condition, frequent dosing, information about dietary consideration, understanding of proper gastrointestinal condition and importance of determining the side effect which will help in managing the patient’s condition and making effective decisions related to the adherence towards and anticoagulant selection.
Park & Jang (2021) highlighted that non-adherence is one of the main contributors in the occurrence of adverse events which negatively impacts the clinical outcome among the patients treated with warfarin. The researcher in this case performs the multiple regression analysis to understand the factors which influence the medication adherence among the patient taking anticoagulation drugs. The result of this study highlighted that the factors which influence the adherence include consumption of the drug for more than three to five years, awareness about the consumption of drugs including the side effects and the complications, knowledge about the medication uptakes and depression for long-term adherence towards drugs. The study also highlighted that self-efficacy and belief has no such influence upon medication adherence but the most common medication awareness and adherence in the patient is associated with mechanical heart valve knowledge and the development of depression with the long-term consumption of warfarin. The study also highlighted that it is essential to provide proper education to the patient in order to maintain a proper continuous management of anticoagulation drug and delivering the patient with accurate guidance related to the specific diet which needs to be consumed while taking anticoagulant drug and understanding the red flag areas such as contradiction of diet and medication with anticoagulation as it is one of the major factor for increasing the self-management strategies among the patient suffering from cardiovascular disease. Yao et al., (2016) performed a study for determining the effect off adherence towards oral anticoagulants on the risk of stroke and development of major bleeding among the patient suffering from atrial fibrillation. The study highlighted that in comparison to warfarin the consumption of non-vitamin K antagonist oral anticoagulant is more beneficial as the dose of the drug, drug interaction and monitoring of the patient condition is much easy. The result of the study highlighted that the rate of non-adherence is higher among the patient suffering from heart failure, transient ischemic attack, diabetes mellitus, vascular disease and older adult. The non-adherence is also higher for stroke, intracranial haemorrhage and bleeding.
Mayet (2016) highlighted the fact that warfarin is one of the commonly prescribed as an oral anticoagulant but the rate of patient non-adherence is also high. The result of the study highlighted the fact that no such association is evident between the warfarin therapy and time of dose and it is also found that 46% of the patients have higher adherence towards this drug and the rate of non-adherence is highest among the female patient. The occupational status such as an employment status is also found to impact the patient’s condition which increases the chance of non-adherence and older adults have lowered adherence due to poor education which need to be addressed through proper patient education intervention in order to increase the chance of addressing the anticoagulant drug. Ti Chen et al., (2019) aimed at investigating the adherents towards the anticoagulant drug and the factor which is found to lower the adherence. The researcher in this case addresses the factor which includes clinical variables, demographics, atrial fibrillation, knowledge, satisfaction with the provided service, severity, perceived barriers, benefits and self-efficacy of the patient in adhering towards the medication. The result of the study highlighted that the difference between adherence towards the anticoagulation drug warfarin insignificant and the linear regression analysis identified that passive behaviour creates a barrier which is significantly associated with the predictor of anticoagulation adherence. The study also highlighted that with every unit increase in the barrier, the increase in non-adherence is 0.48 but a proper self-efficacy and patient education must be provided to the patient which will help in increasing the adherence towards anticoagulation therapy. Hence, the patient’s education must consist of better self-efficacy and it will in turn lower the chance of developing recurrence of stroke. Salmasi et al., (2019) highlighted that medication cannot be provided to the patient without proper patient education and it is essential to deliver proper care and education related to the medicine which is usually prescribed to the patient suffering from cardiovascular disease mostly atrial fibrillation. The study also highlighted that the non-adherence occurs within 1 year to 1.6year. The non-adherence is mostly for certain drugs such as apixaban, rivaroxaban, dabigatran. The study also highlighted that inadequate warfarin increases the risk of non-adherence. Matalqah (2019) stated that patient information and understanding about therapy is one of the essential factors which increases the risk of developing non-adherence towards drugs. The study also highlighted that the factors which needs to be considered includes patient’s understanding about the drug, side effects about the drugs, noncompliance towards medication and cost of treatment. The study also highlighted that medication counselling along with education which help in better understanding and increasing the patient’s acceptance for consuming drugs as it will help in lowering the chance of drug overdosing (Mansukhani et al., 2021).
Praxedes et al., (2020) performed the study for assessing the patient’s knowledge on oral anticoagulation and thereby determining the adherence and knowledge. The research in this case was found to develop response item theory in order to evaluate the knowledge with the help of oral anticoagulation knowledge test item and to determine the patient’s understanding in using adherence towards anticoagulation drugs. The result of the study highlighted that the patient showed positive knowledge in consuming oral anticoagulation drugs but there were issues in understanding the drug and drug of food interaction which affects the adherence towards the medication. The result of the study highlighted that a proper patient assessment including the patient knowledge must be done in order to structure the health educational activity for delivery individualized education for the patient recommended with warfarin. Rakhshan et al., (2019) highlighted that the incident of cardiovascular disease increases the death rate among the population which needs proper investigation of self-management including knowledge among the patients suffering from atrial fibrillation. The result of the study highlighted that implementation of proper sales management plan helps in enhancing the treatment and lifestyle in managing atrial fibrillation and it is the responsibility of the health care professional to assess the patient knowledge related to various factors such as psychological, social including the negative outcome which impact the lifestyle and enhances the chance of developing atrial fibrillation.
Vinereanu & Matei (2017) performed the randomized control trial study for determining the multifaceted intervention in order to improve the treatment among the patient suffering from atrial fibrillation and consuming oral anticoagulant. It has been determined that atrial fibrillation is considered to be an irregular and very rapid heart rhythm which is also known as arrhythmia which ultimately results in clotting of blood in the heart and enhances the risk of developing heart failure, stroke and heart related complications. Similarly, anticoagulant medication is found to be recommended to the patient suffering from cardiac arrhythmia which helps in preventing blood clot and lowers the chance of developing serious complications including heart attack and stroke. The researcher in this case conducted a randomized control trial study and a cluster that was randomized in the ratio of 1:1 in order to provide proper quality improvement intervention and usual care. The intervention group received proper education with frequent feedback and monitoring which helped in understanding the changes among the patients related to the treatment of oral anticoagulants from the baseline till the evaluation of the patient condition after 1 year. The result of the study highlighted that 2281 patient from 5 different countries were included in the study and it is clearly determined that the implementation of oral anticoagulant drug helped in increasing the adherence towards the treatment process in the intervention group up to 80% which was 68% at the baseline where in the control group the increase was found to be 64% with respect to 67%. Hence the study clearly determined that the implementation of multifaceted and multilevel educational intervention helps in improving the adherence towards oral anticoagulation among the patients suffering from atrial fibrillation and it also increases the risk of developing stroke with significant increase in treatment adherence. Raparelli et al., (2017) performed a study for determining the importance of proper adherents towards oral anticoagulant therapy among the patients suffering from atrial fibrillation. The study highlighted that oral anticoagulation is one of the most effective interventions which helps in reducing the thromboembolic risk among the patient with nonvalvular atrial fibrillation. The study highlighted that effective anticoagulation helps in avoiding major side effects and adherence towards anticoagulation helps in providing proper anticoagulation effect among the patient by reducing the chance of blood clotting. The study highlighted that recommending the patient with non-vitamin K antagonist oral anticoagulants is effective and safe among the patient. The study highlighted that a proper multilevel approach which includes patient preferences, variability in adherence and persistent needs to be considered and the clear support must be provided to the patient by the health care professional which will improve the adherence towards the anticoagulation and initiation of adherence can be done through effective monitoring. The study highlighted that educational program are one of the easiest tools to change the behaviour of the patient and it will also help in long term adherence towards the treatment process by understanding the patient’s concern and recommending proper strategy to increase the consumption of oral anticoagulation. Gebreyohannes et al., (2021) performed the study for determining the effectiveness of implementing proper guidelines in order to increase the adherence towards anticoagulants among the patients suffering from atrial fibrillation. The study highlighted that clinical guideline related to atrial fibrillation will help in optimizing the behaviour towards the use of proper anticoagulant and it will also help in lowering the issue of non-adherence towards anticoagulant drugs within the primary health care setting. The researcher in this case conducted a systematic review and the total number of 33 studies were included all the studies which was eligible with the search strategy helped in understanding the fact that it is essential to implement the proper guideline related to the adherence and consumption of anticoagulant drug among the patient which will help in improving the address by the patient and the involvement of pharmacist in the prescription of drug and providing patient education will be effective in lowering the incident of stroke. The study also highlighted that collaborative care including the special is support and pharmacist and understanding of the proper international guidelines related to the medication adherence will help in improving the quality of care and it will enhance the long-term adherence towards the anticoagulant drug for preventing the risk of developing stroke. Desteghe et al., (2018) performed the study for determining the importance of daily monitoring-based feedback in order to improve the adherence towards non vitamin K antagonist oral anticoagulants among the patient suffering from atrial fibrillation and preventing the risk of developing heart attack or stroke. The result of the study highlighted that persistent level of adherence towards proper medication was high with the telemonitoring system and the study also determined that daily monitoring led patient education helps in increasing the long-term adherence towards the treatment process and direct feedback further improved the consumption of anticoagulants. The study also highlighted that the intake of medication was also significantly higher and the feedback process helped in reducing the treatment cost in order to prevent stroke which helped in increasing trust and long-term adherence towards the anticoagulant medication system by the patient. Hence, the telemonitoring system is one of the effective processes for improving the treatment plan and it also helps in lowering the risk of developing adverse health outcomes.
Durand et al., (2020) highlighted that direct anticoagulant is found to be replaced among the patients suffering from stroke or atrial fibrillation and the consumption of warfarin is found to be replaced for preventing stroke among the patients suffering from atrial fibrillation. The aim of the study is to compare the safety and efficacy of various anticoagulant drug such as apixaban, dabigatran and rivaroxaban versus warfarin for treating stroke patient and preventing the chance of developing the recurrence of atrial fibrillation. The researcher in this case was found to perform a population-based observational study where the patient suffering from atrial fibrillation initiated with anticoagulant therapy was included in the study. The researcher in this case assessed the primary outcome for understanding the prevalence of stroke among the included patient. The secondary outcome which was found to be analysed in the patient includes the major cause of bleeding, understanding the mortality and morbidity rate and lastly the study also aimed at analysing the systemic embolization. The result of the study clearly highlighted the fact that a total number of 128273 patients were found to be initiated with anticoagulant drugs and almost 128 273 patients were also found to initiate warfarin drugs. The result of the study clearly highlighted the fact that the patient with direct oral anticoagulant consumption was found to be reported with lower level of major bleeding cause and the mortality rate was also found to decrease among the patient. Hence in this case it can be stated that proper educational intervention needs to be provided to the patient in consuming direct oral anticoagulant medication which will help in preventing the chance of developing atrial fibrillation incidents. Patti et al., (2017) highlighted that the patient suffering from atrial fibrillation can be provided with non-vitamin K antagonist oral anticoagulation in order to prevent the chance of developing various complications which is often observed among the patient adhering towards warfarin drug. The primary outcome which was measured by the researcher includes the development of stroke or systemic embolism, development of major bleeding, intracranial bleeding and vascular death. The study highlighted that the incidence of complication was found to be higher among the diabetic patient in comparison to non-diabetic patients and in this case proper education and recommendation must be provided in order to improve the advent and prevent the chance of developing complications. The result of the study highlighted that no such interaction between the benefit of non-vitamin K antagonist oral anticoagulant drugs was found with the occurrence of major bleeding, stroke and ischemic stroke. The study results highlighted that the patient adhering to the non-vitamin K antagonist oral anticoagulation drug was reported to have lower death rate in comparison to the patient adhering to the warfarin drug. Silverio et al., (2019) aimed at evaluating the safety and efficacy of non-vitamin K oral antagonist drug versus vitamin K antagonist drug among patients suffering from atrial fibrillation. The researcher in this case aimed at assessing the primary outcome as the safety and efficacy of the drug and development of ischemic embolism and stroke including major bleeding among the patient. The result of the study clearly determined the fact that the risk of developing systemic embolism and stroke was found to be lowered among the patient consuming non vitamin K antagonist oral anticoagulation in comparison to vitamin K antagonist. The study also highlighted that no such difference in the major bleeding was found to be evident in the group. the study also highlighted the fact that the non-vitamin K antagonist oral medication helps in reducing the various complications including fattal bleeding, intracranial bleeding and development of hemorrhage stroke. The result of the study also highlighted the fact that the incidence of gastrointestinal bleeding was found to be higher in the group and hence proper education related to the complications needs to be provided to the older patient suffering from stroke or atrial fibrillation and consuming anticoagulant drugs.
Guo et al., (2017) performed the study for determining the impact of mobile health technology for improving the management of patients suffering from atrial fibrillation by involving the patient in the care of the process, providing effective education and implementing an integrated decision support system. The study highlighted that mobile health technology is found to be increasing in today’s world especially in healthcare technology and it is also proposed for improving the condition of cardiovascular disease. It is noted that the feasibility of mobile health technology is found to be limited in providing care to the patient suffering from atrial fibrillation and then effective intervention can be implemented after conducting advanced research which will also help in increasing the use of anticoagulant in a satisfactory level for improving the quality of life and reducing the long-term cost of developing disease. The study highlighted that atrial fibrillation is one of the most common cardiac arrhythmias which increases the global health burden and almost 33.5 million individual suffers from atrial fibrillation all around the world and the condition can be controlled by successful adherence towards anticoagulant drug by the patient. The result of the study highlighted that 113 patient were randomly assign into the two group while 96 patient was found to be randomly assigned in the usual care group and the result of the study clearly highlighted the fact that 90% of the patient found the implementation of mobile health application for understanding the patient preference, providing the collaborative care and providing patient education is found to be higher and significant in terms of usual care. The result of the study also determines that the quality-of-life score was significantly increased in the intervention group and the level of depression and anxiety was found to be higher among the patient belonging to the control group which clearly highlights the fact that patient education with proper adherence towards patient wish helps in improving the adherence towards medication especially anticoagulant drug and lowers the long-term treatment cost.
Tzikas et al., (2020) aimed at assessing the impact of any educational motivational interview in increasing the adherence towards oral anticoagulation drugs among the patients suffering from atrial fibrillation. The researcher in this case was found to provide educational intervention with the help of randomized control trial study when the primary outcome was to understand the effect of Motivational interview in improving the overall consumption of anticoagulant drug among the patient after 1 year. The secondary outcome which was found to be analyzed by the researcher include the rate of persistence towards anticoagulant consumption, the development of various clinical events due to lack of proper consumption of the drug and lastly the treatment gap which is present among the patient in the one year of follow up. The attendance rate which was found in the treatment group was 55% in comparison to the control group within a confidence interval of 95%. The adherence rate which was found in the treatment group was 55% in comparison to the control group within a confidence interval of 95%. The result of the study clearly highlighted the fact that Implementation of proper motivational interview for the patient suffering from atrial fibrillation and recommended with anticoagulant drug is effective in improving the adherence towards the drug and reducing the chance of developing complication aur development of major clinical event including the treatment gap. The result of the study also highlighted the fact that the development of clinical events was the same in 2 year of median period which clearly determined the fact that providing the patient with proper motivational interview helps in improving the adherence towards anticoagulant drugs. Tzikas et al., (2020) highlighted that oral anticoagulation is one of the drugs which helps in delivering effective thromboprophylaxis and there exists limited evidence related to the adherence of anticoagulant drugs among the patients suffering from atrial fibrillation. The researcher in this case aimed at assessing the impact of educational motivational interview in increasing the adherence towards oral anticoagulant drugs among the patient suffering from atrial fibrillation. The researcher in this case performed the randomized control trial study and the primary outcome was to understand the adherence towards anticoagulant drug in 1 year including the secondary outcome highlighted about the gap in the treatment and understanding the clinical event which developed in the follow-up period. The result of the study highlighted that out of 1009 patients included in the study, 500 participants were involved in the intervention group whereas 509 patients were found to be involved in the control group. The result of the study highlighted the fact that after 1 year, 77.2 percent of the patients were found to have greater adherence towards anticoagulant drugs after receiving proper motivational interviews in comparison to the control group which was 55%. The patient in the intervention group of motivational interviews was found to have greater adherence and persistence after one year in comparison to the control group acquiring normal medication care. Hence in this case the study clearly addresses the fact that the patient adherence and educational intervention including motivational interview will help in increasing the adherence of the drug and preventing the chance of developing an adverse effect such as atrial fibrillation among the patient recommended with anticoagulant medication. Jingjing et al., (2019) aimed at investigating the effect of motivational interview in patients suffering from atrial fibrillation and recommended with anticoagulant drugs such as warfarin. The researcher in this case was found to conduct an observational study by providing proper education in order to increase the adherence towards warfarin in therapy. The result of the study highlighted the fact that Incidence of self-management among the patient was found to be increased after discharge including 1, 3 and 6 months and the optimal condition was also found to be higher in the treatment group which was 76.6 5% in comparison to the observational group which was 68.97%. Hence in this case it can be clearly identified that improving the self-awareness by delivering proper motivational interviews for the patient suffering from atrial fibrillation helps in improving the adherence towards anticoagulant drugs and prevent the chance of recurrence of atrial fibrillation.
Clarkesmith et al., (2017) performed the study for understanding the importance of educational and behavioural intervention for anticoagulants. The study highlighted the importance of oral anticoagulation therapy for the patient suffering from atrial fibrillation as it increases the risk of developing stroke. The study highlighted that non adherence towards medication increases the risk of developing stroke or cardiovascular disease which enhances the treatment cost of the patient and enhances the death rate. The result of the study highlighted that a total number of 2246 patients were included in the study. The study which focused upon self-monitoring, education and decision making improved the educational intervention among the patients suffering from atrial fibrillation and recommended anticoagulation therapy. The study stated that educational intervention helped in reducing anxiety and depression among the patient by increasing the understanding about the medication application and effectiveness. Hence, in this case, a proper educational intervention needs to be implemented for the patient in order to increase the medication adherence and lowering medication cost. Zhao et al., (2017) performed a study for determining the factors which influences the medication beliefs and knowledge upon warfarin towards the adherence of the medication. The study highlighted that warfarin is one of the medications which helps in preventing ischemic stroke among the patient suffering from atrial fibrillation. The study highlighted that adherence towards medication is one of the effective interventions for preventing the chance of developing complications and patients suffering from atrial fibrillation. The study highlighted that addressing warfarin adherence is important for improving the poor adherence towards medication and it also increases the death rate among the individual. The reasons for warfarin non-adherence include lack of proper knowledge about the medication prescribed, clinical knowledge, demographics and behavioural factors. The result of the study highlighted those 188 patients completed the survey and the major risk of the factor which resulted in non-adherence to medication includes age of the patient, development of cardiovascular disease, lack of proper belief in adherence towards medication along with that negative effect which increases the harmful consequences. Chen et al., (2019) performed the study for investigating the anticoagulant adherence and associated factors such as clinical variables, demography, atrial fibrillation and other factors such as satisfaction with the service, severity of the symptom and perceived barriers associated with the atrial fibrillation. The researcher in this case collected data using the questionnaire as the study aims at collecting the evidence and perception from the patient adhering to the medication and suffering from atrial fibrillation. The result of the study highlighted that a total number of 151 patients suffering from atrial fibrillation were included in the study and were recommended with warfarin. The other 98 patient was found to be treated with oral anticoagulant and the study highlighted that the difference between the two drug was in significant and the barrier which is associated with the non-adherence towards medication is self-efficacy in assessing the drug and perceived barriers such as negative belief of developing complication increases the risk of developing severe condition and hence a proper patient education must be implemented for enhancing the self-efficacy and reducing the barrier.
Lip et al., (2018) highlighted the innovative strategies in order to improve the adherence to words non-vitamin k antagonist oral anticoagulant drugs for preventing stroke among the patients suffering from atrial fibrillation. The study highlighted that stroke prevention is one of the principal priorities among the patients suffering from atrial fibrillation and the recommendation of oral anticoagulation is associated with significant reduction in the development of systemic embolism and it also helps in preventing the mortality rate by reducing the disease. The study highlighted that vitamin K antagonist is marked as interpatient and interpatient variability and the therapeutic effect gained through the drug helps in lowering the chance of developing atrial fibrillation. The study highlighted that patient counselling and education helps in better management of anticoagulation and the implementation of smartphone technology will act as a reminder system for the patient which will help in delivering education such as drug management and associated side effects and thereby decreasing the fear among the patient and enhancing the adherence towards the treatment process. Geary & Euler (2020) performed the study for determining the importance of feedback and audit intervention for the patients suffering from atrial fibrillation and improving the use of anticoagulants in order to reduce the chance of complications such as development of stroke and heart attack. The study highlighted that improving the use of anticoagulant among the patient is found to be challenging which increases the long-term risk and the suboptimal anticoagulant used is partly due to physician non-prescription and in this case, it is highly essential to control the behaviour and increasing the education among the patient for enhancing the adherence towards anticoagulant drugs through proper feedback and audit. The result of the study highlighted those 94 centres received the intervention and a total number of 31477 patients were included in the study. The intervention of audit and feedback was successful for increasing the adherence towards the treatment process and the rate of adherence was found to increase from 76% to 82% after implementation of the intervention. Hence, the feedback and audit intervention are one of the effective patient education interventions for improving the knowledge and adherence towards the drug.
Contreras et al., (2018) performed the study for understanding the strategies in order to improve the dabigatran adherence in order to prevent stroke among the patient suffering from nonvalvular atrial fibrillation. The study highlighted that it is essential to assess the importance of educational and reminder calendar systems for improving the therapeutic adherence among the patients suffering from nonvalvular atrial fibrillation. The researcher in this case divided the participants into two groups with the control group was provided with usual care and the intervention group was provided with support such as healthcare education and use of a calendar for providing reminders for consuming anticoagulant medication. The results of the study highlighted that almost 659 patients completed the survey and the rate of daily compliance was 91.97% for 6 month and that of 90 1.01 % after 12 months of providing the intervention. The adherence towards medication was also found to be increased in this case and the patient had improved knowledge about the medication adherence related to the time of drug and the doses which helped in preventing the chance of developing complications and helped in changing the behaviour by facilitating the evidence towards medication for preventing the chance of developing stroke. Yao et al., (2016) performed a study for determining the effectiveness of non-vitamin K antagonist and warfarin in terms of advantages of easy dosing, drug interactions and lack of proper monitoring system. The result of the study stated that the patient suffering from congestive heart failure, diabetes mellitus, hypertension has highest risk of developing complication among the patient and the non-adherence towards medication increases the risk of developing intracranial haemorrhage which can be increased by proper patient education. The study also stated that the adherence towards anticoagulant drug is poor which needs to be increased by proper patient education.
Bartolazzi et al., (2021) highlighted that oral anticoagulation therapy is one of the most effective interventions and it can be recommended to the aging population due to higher prevalence of atrial fibrillation. It has been evident that medication adherence is one of the main issues among the older patients suffering from atrial fibrillation and it requires an effective health literacy in order to increase the adherence towards drugs. The highest prevalence of non-adherence is found to be among the patient belonging to poor socioeconomic status and has limited knowledge about the adherence to drug. The implementation of patient education and improving health literacy will enhance the adherence to medication by understanding the effectiveness of the drug in preventing complications and lowering the long-term treatment cost among the patient.
Saade et al., (2021) highlighted that the adherence rate of the patient towards medication impacts the primary and secondary outcome. It is also highlighted that the secondary outcome which is usually analyzed in this study helps in understanding the barriers in proper adherence towards medication among the stroke survivors in various countries. The researcher in this case was found to conduct a cross-sectional study where the medication adherence including the potential barrier was found to be analyzed with the help of medication adherence scale. The result of the study highlighted that 83% of the patients were found to show better adherence towards medication and out of that 27.3% of the patients was found to have disability on the other hand 60 7.3 % of the patients were reported to experience fatigueness. The result of the study also determined the fact that the medication adherence score is associated with social security including insurance which also increased the side effect of the drug due to the prolonged cost of the adherence. The result of the study clearly determines the fact that lack of proper social security is one of the major drawbacks in medication adherence which increases the side effect of the drug and lowers the adherence towards proper medication. Jang (2021) highlighted the fact that one of the most common drugs which is found to be recommended for the patient suffering from atrial fibrillation includes warfarin. The study highlighted that it is highly difficult to manage the patient due to lack of proper therapeutic range and including the individual differences. The research aimed at analyzing the health education impact upon the patient recommended with warfarin therapy by implementing mobile application technologies. the researcher highlighted that tablet applications including mobile phone applications play a potential role in educating the patient by providing them with proper notification and timing of the drug and thereby plays an essential role in improving the adherence towards the drug. The researcher in this case conducted a systematic review by analysing 414 articles. The study clearly determined that the education and self-management program with the use of mobile health applications was found to give diverse content to the patient and it also helps in improving the quality of life by delivering the patient with proper support. The study result also clearly address the fact that educating patient for improving the adherence towards anticoagulant medication with the help of smartphone and tablet helps in increasing the medication awareness, enhances the self-satisfaction of the patient, it increases the knowledge level, improves the clinical outcome and prevents the chance of developing complication by increasing the awareness related to early determination and continuing positive health effect upon the patient. Hence in this case implementation of proper mobile health application play an essential role in improving the self-management and efficacy among the patient suffering from atrial fibrillation and recommended with drugs including warfarin.
Conclusion
The above paper discussed about the importance of patient education in increasing the adherence towards anticoagulation. The development of stroke results in long-term disability and there are almost 7 million stroke survivors residing in the United States and 25% of the patients is found to recover from first stroke within the last 5years. The reoccurrence of stroke also increased the rate from 6.8% to 45%. It is also highlighted that the patient who consumes warfarin is reported to have long-term non-adherence to a drug. The occupational status such as an employment status is also found to impact the patient’s condition which increases the chance of non-adherence and older adults have lowered adherence due to poor education which need to be addressed through proper patient education intervention in order to increase the chance of addressing the anticoagulant drug.
References
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