Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial.

<h4>Background</h4>Stroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its treatment may contribute to th...

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Autores principales:	Danielle E Clarkesmith, Helen M Pattison, Gregory Y H Lip, Deirdre A Lane
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/bb92a894ecec4be1b5fb7207a57ab1e3
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spelling	oai:doaj.org-article:bb92a894ecec4be1b5fb7207a57ab1e32021-11-18T08:56:11ZEducational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial.1932-620310.1371/journal.pone.0074037https://doaj.org/article/bb92a894ecec4be1b5fb7207a57ab1e32013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24040156/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Stroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its treatment may contribute to the patient's willingness to adhere to recommendations.<h4>Method</h4>A theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1-6 patients) utilising an "expert-patient" focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605) against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD) 72.0 (8.2), 67.4% men), or usual care (n=51, mean age (SD) 73.7 (8.1), 62.7% men), stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR); secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions.<h4>Main findings</h4>Intervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035); at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44). Knowledge increased significantly across time (F (3, 47) = 6.4; p<0.01), but there were no differences between groups (F (1, 47) = 3.3; p = 0.07). At 6-months, knowledge scores predicted TTR (r=0.245; p=0.04). Patients' scores on subscales representing their perception of the general harm and overuse of medication, as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months.<h4>Conclusions</h4>A theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients' understanding of the necessity of warfarin and reducing their perception of treatment harm. Improving education provision for AF patients is essential to ensure efficacious and safe treatment. The trial is registered with Current Controlled Trials, ISRCTN93952605, and details are available at www.controlled-trials.com/ISRCTN93952605.Danielle E ClarkesmithHelen M PattisonGregory Y H LipDeirdre A LanePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 9, p e74037 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Danielle E Clarkesmith Helen M Pattison Gregory Y H Lip Deirdre A Lane Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial.
description	<h4>Background</h4>Stroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its treatment may contribute to the patient's willingness to adhere to recommendations.<h4>Method</h4>A theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1-6 patients) utilising an "expert-patient" focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605) against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD) 72.0 (8.2), 67.4% men), or usual care (n=51, mean age (SD) 73.7 (8.1), 62.7% men), stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR); secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions.<h4>Main findings</h4>Intervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035); at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44). Knowledge increased significantly across time (F (3, 47) = 6.4; p<0.01), but there were no differences between groups (F (1, 47) = 3.3; p = 0.07). At 6-months, knowledge scores predicted TTR (r=0.245; p=0.04). Patients' scores on subscales representing their perception of the general harm and overuse of medication, as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months.<h4>Conclusions</h4>A theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients' understanding of the necessity of warfarin and reducing their perception of treatment harm. Improving education provision for AF patients is essential to ensure efficacious and safe treatment. The trial is registered with Current Controlled Trials, ISRCTN93952605, and details are available at www.controlled-trials.com/ISRCTN93952605.
format	article
author	Danielle E Clarkesmith Helen M Pattison Gregory Y H Lip Deirdre A Lane
author_facet	Danielle E Clarkesmith Helen M Pattison Gregory Y H Lip Deirdre A Lane
author_sort	Danielle E Clarkesmith
title	Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial.
title_short	Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial.
title_full	Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial.
title_fullStr	Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial.
title_full_unstemmed	Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial.
title_sort	educational intervention improves anticoagulation control in atrial fibrillation patients: the treat randomised trial.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/bb92a894ecec4be1b5fb7207a57ab1e3
work_keys_str_mv	AT danielleeclarkesmith educationalinterventionimprovesanticoagulationcontrolinatrialfibrillationpatientsthetreatrandomisedtrial AT helenmpattison educationalinterventionimprovesanticoagulationcontrolinatrialfibrillationpatientsthetreatrandomisedtrial AT gregoryyhlip educationalinterventionimprovesanticoagulationcontrolinatrialfibrillationpatientsthetreatrandomisedtrial AT deirdrealane educationalinterventionimprovesanticoagulationcontrolinatrialfibrillationpatientsthetreatrandomisedtrial
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Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial.

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