Discrepancies between Patients’ Preferences and Educational Programs on Oral Anticoagulant Therapy: A Survey in Community Pharmacies and Hospital Consultations

BackgroundOral anticoagulation therapy is increasingly used for the prevention and treatment of thromboembolic complications in various clinical situations. Nowadays, education programs for patients treated with anticoagulants constitute an integrated component of their management. However, such programs are usually based on the healthcare providers’ perceptions of what patients should know, rather than on patients’ preferences.ObjectiveTo investigate patients’ viewpoints on educational needs and preferred modalities of information delivery.MethodsWe conducted an observational study based on a self-administered questionnaire. To explore several profiles of patients, the study was designed for enrolling patients in two settings: during outpatient consultations in a cardiology department (Saint Antoine Hospital, Paris, France) and in community pharmacies throughout France.ResultsOf the 371 patients who completed the questionnaire, 187 (50.4%) were recruited during an outpatient consultation and 184 (49.6%) were recruited in community pharmacies. 84.1% of patients were receiving a vitamin K antagonist and 15.6% a direct oral anticoagulant. Patients ranked 16 of 21 (76.2%) questionnaire items on information about their treatment as important or essential; information on adverse effects of treatment was the highest ranked domain (mean score 2.38, 95% CI 2.30–2.46). Pharmacists (1.69, 1.58–1.80), nurses (1.05, 0.95–1.16), and patient associations (0.36, 0.29–0.44), along with group sessions (0.85, 0.75–0.95), the internet (0.77, 0.67–0.88), and delivery of material at the patient’s home (1.26, 1.14–1.38), were ranked poorly in terms of delivering educational material.ConclusionThis study revealed substantial discrepancies between patient preferences and current educational programs. These findings should be useful for tailoring future educational programs that are better adapted to patients, with a potential associated enhancement of their effectiveness.【背景】口服抗凝治疗（oral anticoagulation therapy）在各类临床场景中愈发广泛地用于血栓栓塞并发症的预防与治疗。当前，针对接受抗凝治疗患者的教育项目已成为其诊疗管理中的核心组成部分。然而，此类项目通常基于医疗服务提供者对患者应知内容的认知制定，而非依据患者自身的偏好。 【目的】探究患者对于教育需求的看法，以及其偏好的信息传递方式。 【方法】本研究采用基于自填式问卷的观察性研究设计。为覆盖不同特征的患者群体，研究在两类场景中招募受试者：一是法国巴黎圣安东尼医院（Saint Antoine Hospital）心内科的门诊就诊患者，二是法国全境社区药房的就诊或咨询患者。 【结果】共回收有效问卷371份，其中187例（50.4%）来自心内科门诊就诊患者，184例（49.6%）来自社区药房招募的患者。84.1%的受试者接受维生素K拮抗剂（vitamin K antagonist）治疗，15.6%接受直接口服抗凝药（direct oral anticoagulant）治疗。针对治疗相关信息的21项问卷条目中，16项（76.2%）被患者评为"重要"或"极为重要"；其中，治疗不良反应相关信息的评分最高（平均得分2.38，95%置信区间（Confidence Interval, CI）2.30~2.46）。而药师、护士、患者协会，以及小组讲座、互联网渠道、上门递送教育材料的评分均较低：药师为1.69（95%CI 1.58~1.80）、护士为1.05（95%CI 0.95~1.16）、患者协会为0.36（95%CI 0.29~0.44）、小组讲座为0.85（95%CI 0.75~0.95）、互联网为0.77（95%CI 0.67~0.88）、上门递送为1.26（95%CI 1.14~1.38）。 【结论】本研究发现，患者偏好与当前的抗凝治疗教育项目之间存在显著差异。上述研究结果可为未来定制更贴合患者需求的教育项目提供参考，有望提升此类项目的实施效果。