| Abstract (croatian) | Although warfarin was the most commonly used oral anticoagulant,
the DOACs ( direct oral anticoagulants - dabigatran,
apixaban and rivaroxaban) are the mainsteream of anticoagulation therapy
today. Patients' satisfaction with anticoagulation therapy is important because it
can effect adherence and therapy outcomes. Validated questionnaires used to
measure patients' satisfaction with anticoagulants exist, like the DASS questionnaire
(Duke anticoagulation satisfation scale). Until now, in Croatia, testing of
anticoagulants satisfaction with DASS was carried out only for warfarin.
The aim of the study was to compare the satisfaction and adherance of patients
on warfarin and DOACs. The research was conducted from November 2017 to
May 2018 with the help of public pharmacies in the area of Zagreb and Slavonski Brod and its surroundings. Patients over the age of 18 who use therapy for more
than three months were included after signing the informed consent. The demographic
and clinical information were collected patients filled out the DASS and
adherence questionnaire. The study included 88 patients, of whom 46 were on
warfarin and 42 on DOACs. Of the total number of patients on DOACs, half of
the patients had used warfarin before the present therapy.
The average DASS sum of all patients in total showed high satisfaction with
therapy (56.14 ± 21.79). Patients on DOACs showed statistically significantly
greater satisfaction than those on warfarin (p = 0.007). In the category of psychological
effects, those who currently use DOAC and have used warfarin earlier
have also shown greater sastifaction than those who have not previously used it.
There was a statistically significant correlation between bleeding and poorer
satisfaction, as much as poorer satisfaction and lower adherence.
Adherence was measured by the MMAS-4 scale (Morisky Medication
Adherence Scale) and based on adherence patients were divided in three groups
(low, middle and high level of adherence). The majority of patients from both
groups were categorized as middle level adherence, and there was a statistically
significant difference in the number of patients with middle level adherence
between DOAC and warfarin groups (chi-square test, p=0,012). The variability
of adherence was higher in the warfarin group compared to the DOAC group.
Low level of adherence was detected in 7,1 % of patients taking warfarin, while
there were no patients with low adherence in DOAC group. High level of adherence
was measured for 45,2% of patients in warfarin group compared to 26,8%
of patients in DOAC group, with no statistical difference.
It is important to realize how patients feel about their therapy and how
much they know about it and also connect their satisfaction to certain patient
subgroups with regard to demographic and clinical data in order to improve the
quality of their life. lt is also important to assess the degree of adherence, its
impact on therapy, and satisfaction, and identify the reasons for poor adherence
so that healthcare professionals know how to act for its improvement. |
