Assessing the quality, suitability and readability of internet-based health information about warfarin for patients.

BACKGROUND: Warfarin is a high-risk medication where patient information may be critical to help ensure safe and effective treatment. Considering the time constraints of healthcare providers, the internet can be an important supplementary information resource for patients prescribed warfarin. The usefulness of internet-based patient information is often limited by challenges associated with finding valid and reliable health information. Given patients' increasing access of the internet for information, this study investigated the quality, suitability and readability of patient information about warfarin presented on the internet. METHOD: Previously validated tools were used to evaluate the quality, suitability and readability of patient information about warfarin on selected websites. RESULTS: The initial search yielded 200 websites, of which 11 fit selection criteria, comprising seven non-commercial and four commercial websites. Regarding quality, most of the non-commercial sites (six out of seven) scored at least an 'adequate' score. With regard to suitability, 6 of the 11 websites (including two of the four commercial sites) attained an 'adequate' score. It was determined that information on 7 of the 11 sites (including two commercial sites) was written at reading grade levels beyond that considered representative of the adult patient population with poor literacy skills (e.g. school grade 8 or less). CONCLUSION: Despite the overall 'adequate' quality and suitability of the internet derived patient information about warfarin, the actual usability of such websites may be limited due to their poor readability grades, particularly in patients with low literacy skills.

Educating patients about warfarin therapy using information technology: a survey on healthcare professionals’ perspectives / Educando a pacientes sobre el uso terapéutico de warfarina utilizando tecnologías de información: estudio sobre perspectivas de profesionales de la salud

Objective: To explore healthcare professionals’ views about the benefits and challenges of using information technology (IT) resources for educating patients about their warfarin therapy. Methods: A cross-sectional survey of both community and hospital-based healthcare professionals (e.g., doctors, pharmacists and nurses) involved using a purpose-designed questionnaire. The questionnaires were distributed using a multi-modal approach to maximise response rates. Results: Of the total 300 questionnaires distributed, 109 completed surveys were received (43.3% response rate). Over half (53.2%) of the healthcare participants were aged between 40-59 years, the majority (59.5%) of whom were female. Fifty nine (54.1%) participants reported having had no access to warfarin-specific IT-based patient education resources, and a further 19 (38.0%) of the participants who had IT-access reported that they never used such resources. According to the healthcare participants, the main challenges associated with educating their patients about warfarin therapy included: patient-related factors, such as older age, language barriers, cognitive impairments and/or ethnic backgrounds or healthcare professional factors, such as time constraints. The healthcare professionals reported that there were several aspects about warfarin therapy which they found difficult to educate their patients about which is why they identified computers and interactive touch screen kiosks as preferred IT devices to deliver warfarin education resources in general practices, hospital-based clinics and community pharmacies. At the same time, the healthcare professionals also identified a number of facilitators (e.g., to reinforce warfarin education, to offer reliable and easily comprehensible information) and barriers (e.g., time and costs of using IT resources, difficulty in operating the resources) that could impact on the effective implementation of these devices in educating patients about their warfarin therapy Conclusion: The findings of the study suggest that there is a need for improving healthcare professionals’ use of, and access to IT-based warfarin education resources for patients. The study findings also suggest addressing the concerns raised by the healthcare professionals when implementing such IT resources successfully to help educate patients about their warfarin therapy (AU)

Objetivo: Explorar la visión de los profesionales de la salud sobre los beneficios y retos de usar tecnologías de información (TI) para educar pacientes sobre su tratamiento con warfarina. Métodos: Estudio transversal tanto de profesionales de la salud comunitarios y hospitalarios (e.g. médicos, farmacéuticos y enfermeras) que envolvió el uso de un cuestionario específicamente diseñado. Se distribuyeron los cuestionarios utilizando un diseño multi-modal para maximizar las tasas de respuesta. Resultados: De los 300 cuestionarios distribuidos, se recibieron 109 completos (43,3% de tasa de respuesta). Más de la mitad (53,2%) de los sanitarios participantes tenían entre 40-59 años y la mayoría (59,9%) eran mujeres. 59 participantes (54,1%) comunicaron no tener acceso a recursos de TI para educación de pacientes específicos de warfarina, y 19 de los que tenían acceso (38.0%) comunicaron que nunca los habían utilizado. De acuerdo con los sanitarios participantes, los principales retos asociados con la educación de sus pacientes sobre el tratamiento con warfarina incluían: factores relacionados con los pacientes, tales como elevada edad, barreras lingüísticas, deterioros cognitivos o antecedentes étnicos, o factores de los profesionales de la salud tales como restricción de tiempo. Los profesionales sanitarios comunicaron que había muchos aspectos del tratamiento con warfarina que encontraban difíciles de explicar a sus pacientes, por lo que identificaron los ordenadores y los quioscos interactivos de pantalla táctil como los aparatos de TI preferidos para proporcionar educación sobre warfarina en las consultas generales, en las clínicas hospitalarias y en las farmacias comunitarias. Al mismo tiempo, los profesionales de la salud también identificaron varios facilitadores (e.g. reforzar la educación sobre warfarina, ofrecer información fiable y fácilmente comprensible) y barreras (e.g. tiempo y costes de usar las TI, dificultad en manejar esos recursos) que podrían impactar en la implantación efectiva de estos aparatos para educar pacientes sobre su tratamiento con warfarina. Conclusión: Los hallazgos del estudio sugieren que se necesita mejorar el uso y el acceso de los profesionales de la salud a los recursos educativos para pacientes basados en TI sobre warfarina. El hallazgos del estudio también sugieren afrontar las preocupaciones levantadas por los profesionales al implantar con éxito tales TI para educar pacientes sobre sus tratamientos con warfarina (AU)

Challenges of older patients' knowledge about warfarin therapy.

OBJECTIVE: To review the challenges of warfarin education for older patients (aged 65 years or older) in terms of knowledge, access to warfarin education, and education resources. METHODS: A quasi-systematic review of the literature was performed via electronic database searches (eg, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Meditext, and Google Scholar) from 1990 to May 2011. RESULTS: The 62 articles reviewed found that improved patient knowledge results in better anticoagulation control. The review also found that between 50% and 80% of older patients have inadequate knowledge about the basic aspects of warfarin therapy (eg, action, benefits and risks, interactions with other drugs or foods, international normalized ratio management). Demographic factors, such as advancing age, lower family income, and limited health literacy, were found to inversely affect patients' warfarin knowledge, and access to warfarin education and information resources were often suboptimal in different practice settings. Finally, a number of educational strategies and resources that could be readily incorporated to improve the effectiveness of current warfarin education programs were extracted from the review. CONCLUSION: This comprehensive review highlights that education about warfarin in older patients is currently suboptimal and may in part contribute to poor therapeutic outcomes. This review article also acknowledges the need to identify, target, and develop educational strategies and resources to further improve older patients' knowledge about their warfarin therapy.

Educating patients about warfarin therapy using information technology: A survey on healthcare professionals' perspectives.

OBJECTIVE: To explore healthcare professionals' views about the benefits and challenges of using information technology (IT) resources for educating patients about their warfarin therapy. METHODS: A cross-sectional survey of both community and hospital-based healthcare professionals (e.g., doctors, pharmacists and nurses) involved using a purpose-designed questionnaire. The questionnaires were distributed using a multi-modal approach to maximise response rates. RESULTS: Of the total 300 questionnaires distributed, 109 completed surveys were received (43.3% response rate). Over half (53.2%) of the healthcare participants were aged between 40-59 years, the majority (59.5%) of whom were female. Fifty nine (54.1%) participants reported having had no access to warfarin-specific IT-based patient education resources, and a further 19 (38.0%) of the participants who had IT-access reported that they never used such resources. According to the healthcare participants, the main challenges associated with educating their patients about warfarin therapy included: patient-related factors, such as older age, language barriers, cognitive impairments and/or ethnic backgrounds or healthcare professional factors, such as time constraints. The healthcare professionals reported that there were several aspects about warfarin therapy which they found difficult to educate their patients about which is why they identified computers and interactive touch screen kiosks as preferred IT devices to deliver warfarin education resources in general practices, hospital-based clinics and community pharmacies. At the same time, the healthcare professionals also identified a number of facilitators (e.g., to reinforce warfarin education, to offer reliable and easily comprehensible information) and barriers (e.g., time and costs of using IT resources, difficulty in operating the resources) that could impact on the effective implementation of these devices in educating patients about their warfarin therapy. CONCLUSIONS: The findings of the study suggest that there is a need for improving healthcare professionals' use of, and access to IT-based warfarin education resources for patients. The study findings also suggest addressing the concerns raised by the healthcare professionals when implementing such IT resources successfully to help educate patients about their warfarin therapy.