The Clinical Outcome Evaluation On The Atrial Fibrillation Patients Receiving Warfarin For Secondary Stroke Prevention In The Medication Therapy Adherence Clinic In Serdang And Seremban Hospitals

Mochamad Djunaedi, Mochamad Djunaedi (2016) The Clinical Outcome Evaluation On The Atrial Fibrillation Patients Receiving Warfarin For Secondary Stroke Prevention In The Medication Therapy Adherence Clinic In Serdang And Seremban Hospitals. PhD thesis, Universiti Sains Malaysia.

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    Abstract

    Di Klinik Kepatuhan Terapi Ubat-ubatan (Warfarin-MTAC), ahli farmasi perlu memainkan peranan dalam pasukan kesihatan pelbagai disiplin untuk meningkatkan kepatuhan pesakit bagi mencapai matlamat terapi warfarin. Matlamat utama kajian ini adalah untuk menilai keberkesanan perundingan ahli farmasi dalam mencapai kualiti yang lebih baik dalam kawalan antikoagulasi. Ia juga bertujuan untuk mengenal pasti faktor-faktor yang menyumbang kepada kegagalan atau kejayaan untuk mencapai INR terapeutik. Suatu kajian prospektif telah dibuat di Warfarin-MTAC yang beroperasi di Unit Jantung di Hospital Serdang dan Hospital Tuanku Ja'afar Seremban pada tahun 2011. Seramai tiga ratus lima puluh dua pesakit yang didiagnosis dengan pemfibrilan atrium memenuhi kriteria kelayakan dan dipilih menggunakan teknik persampelan rawak. Pesakit terdiri daripada kaum Melayu, Cina dan India dengan purata umur 64.2 dan 64.6 tahun memiliki risiko strok kategori sederhana (skor CHADS2: 2.3±1.2 dan 2.7±1.3) untuk pesakit di Hospital Serdang dan Hospital Seremban. Kepatuhan pesakit terhadap terapi warfarin seperti yang dinasihatkan oleh ahli farmasi didapati menjadi faktor penyumbang kepada pencapaian kualiti yang baik dalam kawalan antikoagulasi (nisbah kebarangkalian: 53.3 dan 52.0, p < 0.05; CI = 95%) bagi pesakit di Hospital Serdang dan Seremban. Kawalan didapati mencapai prestasi yang baik dengan %TTR sebanyak (81.1+21.1) % dan (77.9+12.6) % untuk kedua-dua hospital. Kesimpulannya, untuk mengelakkan strok dan pengambilan warfarin yang berlebihan, serta memastikan perundingan yang berkesan dengan ahli farmasi, ahli farmasi perlulah memberi nasihat yang menyeluruh kepada pesakit pemfibrilan atrium yang menerima rawatan warfarin di Klinik Terapi Antikoagulasi dan menekankan keutamaan untuk terapi warfarin. In the Warfarin-Medication Therapy Adherence Clinic (Warfarin-MTAC), pharmacists should play their role in the multidisciplinary health team to improve patients’ adherence in achieving the goal of warfarin therapy. The primary aim of this study is to evaluate the effectiveness of pharmacists’ consultation in order for atrial fibrillation (AF) patients receiving warfarin to achieve better quality of anticoagulation control. It also aims to identify the factors contributing to the failure or success of reaching the therapeutic INR. A prospective study was carried out in the Warfarin-MTAC that operated in the Cardiac Unit of Serdang and Seremban Hospitals in 2011. Three hundred and fifty-two AF-diagnosed patients were represented in the inclusion criteria, selected using the convenience sampling technique. The patients consist of Malay, Chinese and Indian with the mean age of 64.2 and 64.6 years old, and had the CHADS2 score of 2.3±1.2 and 2.7±1.3 for patients in Serdang and Seremban Hospitals, respectively. Patients’ adherence to warfarin therapy as had been guided by Pharmacist was found to be a factor that contributed to the achievement of good quality of anticoagulation control (Odds ratio: 53.3 and 52.0 at p < 0.05 and CI = 95% for those in Serdang and Seremban Hospitals respectively). The anticoagulation control achieved is ‘good’ with %TTR of (81.1 +21.1)% and (77.9+12.6)% for both hospitals. As a conclusion, to prevent stroke and avoid overwarfarinization, and to ensure effective consultation with pharmacists, the pharmacists should provide comprehensive advice to patients with atrial fibrillation who are receiving warfarin treatment at the Anticoagulation Therapy Clinic and emphasize on the prioritized characteristics for the warfarin therapy.

    Item Type: Thesis (PhD)
    Subjects: R Medicine > RS Pharmacy and materia medica > RS1-441 Pharmacy and materia medica
    Divisions: Pusat Pengajian Sains Farmasi (School of Pharmacy) > Thesis
    Depositing User: Mr Noorazilan Noordin
    Date Deposited: 23 Feb 2017 16:55
    Last Modified: 22 Mar 2017 09:59
    URI: http://eprints.usm.my/id/eprint/32204

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