The Warfarin Medication Guide: A Health Literacy Approach to Evaluating Patients’ Understanding
Nissa Mazzola and Mary Ann Howland, College of Pharmacy and Health Sciences, Department of Clinical Phamarcy Practice; Poision Control Center in Manhattan: Lauren Schwartz, Maria Mercurio-Zappala, Robert S. Hoffman, Lewis Nelson
Objectives: To evaluate patients’ understanding of the FDA’s Warfarin Medication Guide and develop a health literacy intervention to increase medication safety.
Methods: Qualitative structured interviews were conducted with 50 newly prescribed warfarin patients at two sites. A series of questions were asked to examine 1) patient understanding of specific sections in the warfarin medication guide, 2) knowledge of warfarin medication therapy, 3) ways to best present patient information about warfarin and 4) health literacy issues. No patient identifiers were necessary or maintained. All answers were collected and written by the Research Coordinator. Data was summarized as a group distinguishable only by the Hospital where it was collected. Patients were given an incentive that included a tote bag, medicine box, medical ID bracelet, and brochures about the Poison Center.
Results: Of the 50 patients that were surveyed, 49 responses were included for analyses. There were slightly more females respondents than males (53.1% vs. 46.9% respectively), with various ages and ethnicities. To determine understanding of the guide, patients were asked to identify specific areas within the medication guide. The majority of patients were able to correctly do so. Over 90% of respondents felt the Medication Guide was a helpful way to present the information about warfarin, but when asked if they could design it themselves, most respondents provided options to help improve the guide, such as including pictures or changing the font to highlight important information. Numeracy questions were also asked to help assess health literacy, with more than 80% of patients answering correctly.
Implications/Conclusion: We were surprised to learn that many patients felt that the medication guide was a helpful tool to provide information about warfarin, however there are still improvements to be made for those with lower health literacy. We intend to use their suggestions to develop new education materials/strategies which will be field tested with a set of patients in each setting. We will also work with hospital staff to develop, implement and evaluate a warfarin checklist. This will ensure that patients are instructed about the components of medication therapy with an outcome of increased knowledge and behavior change by patients taking warfarin.