| By screening several clinical published data which reported that Chinese subjects are more sensitive to warfarin than Caucasian subjects, and by stressing out the importance of the role of patient education in health care and in adherence therapy, two pilots studies have been carried out at Cardio-thoracic surgery department of The Affiliated Drum Tower Hospital of Medical College of Nanjing University. Based on these researches, while in our study pilot A, we try to examine and analyze the effect of two differents warfarin regimens in Chinese patients; warfarin 2.5mg (domestically manufactured) and warfarin 3.0mg (imported) according to INR in patients at their discharge period, our study pilot B evaluated the pharmacist's patient education on warfarin knowledge level and follow up efficacy in Chinese patients.;236 patients treated by domestic warfarin regimen of 2.5mg and 132 patients who were treated by an imported warfarin regimen of 3.0mg were included in our final analysis for our study pilot A. Their mean age was 48.25+/-12.95 years (range 4-74). Although the first group contained a higher proportion of males and females, no statistically significant difference in gender was demonstrated (P=0.099, Table 15). As most of the patients had a prosthetic heart valve replacement, the percentage of patient who will endure this warfarin therapy for a life-time period was significantly higher (P=0.035, Table 15). In terms of residency situation of these patients, we found that most of them were not Nanjing citizens. This gives us a hint to strengthen our patient education and counseling program in order to provide them a high quality of health care services. The proportion of INR in target range was presented as percentage and compared between the group of the patients who were administered warfarin 2.5mg (domestic) and the group of those who were taking warfarin 3.0mg (imported). Statistically significant difference in therapeutic range at discharge time was demonstrated (P=0.032, Table 15).;The database of 47 patients completed our study pilot B. The median patient age was 36 to 64 years with a median hospital-days post-surgery of 11 to 14. In terms of status employment, 57.45% of patients were farmers, 21.27% of patients were employed, 10.64% of patients were retired and also 10.64% of patients were categorized as other due to the information they or their relatives provided during their enrollment into the cardio-thoracic surgery ward.;The Patients with an education greater or equal to university had significantly higher warfarin knowledge scores than those who did not reach such education background (P=0.020; Table 17). Employed patients were found to have significantly higher warfarin knowledge scores when we compared with other patients in employment strata (P=0.037; Table 17). In terms of hospital days post-surgery, the patients with a median hospital day's post-surgery of 11 to 14 days were found to have significantly higher warfarin knowledge compared to others groups (P=0.015; Table 17).;Along during this study, most of the patients were very satisfied (80.85%) for the health care service provided by clinical pharmacist (graph 9). This funding confirms what have been reported in some studies where doctors and nurses in anticoagulation clinic overwhelmingly support the presence of clinical pharmacists, regularly seek their advice, and feel that they improve patient safety and quality of care.;In summary, while several studies were conducted to show the sensitivity of Chinese population to warfarin effect, our study pilot A was the first study to prove statistically however we manage the warfarin low regime and dose needed to be administered, there is a great difference between a warfarin 2.5mg (produced in China) and a warfarin 3.0mg (imported). This study pilot B demonstrated the importance of the patient education program and highlights the satisfaction of the clinical pharmacists' service. Successful anticoagulation treatment is dependent on the patient's knowledge of this drug. From our study pilot B, the results support the funding which states that the socio-educative is one of the potent determinants of health care in patient education. (Abstract shortened by UMI.)... |
