Transcript Exploration of Possible Interest in a Cholesterol

The Use of Oral Anticoagulant
Medications
PRESENTATION:
Key Findings from Surveys of
Patients, Caregivers, and Physicians
Prepared for:
The National Consumers League
September 21, 2005
J23715
Background
• The National Consumers League (NCL), on behalf of the SOS Rx
Coalition (The Coalition), is working on an outpatient medication safety
campaign aimed at consumers, caregivers, and physicians.
• The initial focus of this campaign is on oral anticoagulant drugs.
– Oral anticoagulants, or blood thinners, are highly effective at preventing
blood clots and are used for numerous indications, including stroke and
coronary event prevention.
– Despite their benefit, these agents are known to be relatively difficult to
manage, require frequent monitoring, and may be associated with a large
number of potential interactions with other medications or food.
– The SOS Rx Coalition would like to further explore these potential issues
among patients, caregivers, and physicians in order to help design
outreach and educational campaigns to help consumers and providers
better manage this drug.
• Harris Interactive was commissioned to conduct a survey exploring use
of and experiences with oral anticoagulants.
2
Objectives
– Gain insight into the experiences of patients who are taking oral
anticoagulants particularly issues around managing their medication
regimen, adherence to recommendations, relationships and
communications with their doctors, and sources used for information
to help manage their regimen.
– Gain insight into the experiences of caregivers who assist in the
management of patients’ anticoagulant regimen.
– Gain insight into the physician’s point of view on issues around the
use and management of oral anticoagulant medication.
– Identify opportunities for improving education and communication
about oral anticoagulant treatment, which could improve patient
compliance, safety, and outcomes.
3
Methodology
•
•
Harris Interactive conducted surveys with patients, caregivers, and
physicians about the use of oral anticoagulants.
All three surveys were conducted online within the United States.
•
Patients
– A total of 426 patients were interviewed.
– Patients were sampled from the Harris Interactive Chronic Illness Panel.
– Eligible respondents have been taking an oral anticoagulant medication for
at least 3 months and are at least 30 years of age.
– Interviews conducted between April 4 -15, 2005.
•
Caregivers
– A total of 109 caregivers were interviewed.
– Caregivers were sampled from the Harris Interactive Panel, prescreened as
being the caregiver of someone who is chronically ill.
– Eligible caregivers are taking care of a person who has been on an oral
anticoagulant medication for at least 3 months and is at least 30 years of
age. Further, caregivers must assist the patient in at least 2 out of 11 caregiving tasks around anticoagulant use.
– Interviews conducted between May 19 - 26, 2005.
4
Methodology, continued
•
Physicians
– A total of 101 physicians were interviewed.
– Physicians were sampled from the Harris Interactive Physician Panel.
– Eligible respondents are primary care providers (specializing in family
practice, internal medicine or general medicine) and cardiovascular
specialists, practicing for at least 5 years, spending at least 70% of their
time in direct patient care and treating 5 or more patients who are on an oral
anticoagulant medication.
– Interviews conducted between August 11 - 18, 2005.
– Eligible respondents received a $50 honorarium for completing the survey.
5
Summary of Key Findings
6
Summary of Key Findings: Patients
1.
People on oral anticoagulants face complex health problems
and have considerable health management needs.
2.
Almost all patients on oral anticoagulants also take other
prescription drugs and many take over-the-counter (OTC)
drugs and vitamins/supplements.
3.
According to patients, physicians are overall doing a good job
educating new oral anticoagulant users, but there are gaps in
education about dietary considerations, drug interactions, and
possible side effects.
4.
There are gaps in the management of the health care of
patients on oral anticoagulants.
5.
There is room for improvement in the relationship between oral
anticoagulant users and their physicians.
Continued >
7
Summary of Key Findings: Patients,
continued
6.
7.
Communication about blood test goals should be improved.
Patients are fairly knowledgeable about the things they should
and should not do when taking an oral anticoagulant.
However, actual behavior could be improved upon.
8. Patients have some difficulties and concerns about being on
an oral anticoagulant.
9. Adverse reactions to oral anticoagulants are common. Many
do not change their behavior or seek help.
10. Patients could use more assistance with management of their
oral anticoagulant use. Such assistance is associated with
improved awareness, behavior, and confidence around the
management of oral anticoagulant use.
11. Doctors are the most used, perceived as being the most
useful, and most trusted source of information about what
patients should and should not do when taking an oral
anticoagulant.
8
Summary of Key Findings: Caregivers
1. Caregivers are assisting oral anticoagulant users who have
considerable health management needs.
2. Caregivers are highly involved in helping their family members
manage their oral anticoagulant regimen.
3. Caregivers are generally aware of the complexity of oral
anticoagulant medication, knowledge of precautions could be
improved.
4. Caregivers could use more assistance in helping their family
members with management of their anticoagulant regimen.
5. Nearly one in four caregivers is less than very confident that
their family members are taking the anticoagulant correctly;
Family members need encouragement to follow
recommendations for safe use of medication.
9
Summary of Key Findings: Caregivers,
continued
6.
7.
8.
A small but troubling minority of caregivers report that their family
members experienced adverse reactions to anticoagulant
medications that led to an ER visit and/or hospital stay.
Caregivers rate physicians highly on their responsiveness to
patients; However there is room for improvement in explanations of
precautions both to caregivers and family members.
Doctors are the most used source of information on the dos and
don’ts of managing and anticoagulant regimen.
10
Summary of Key Findings: Physicians
1.
2.
3.
4.
5.
Managing patients on anticoagulant medication is a challenge for
physicians.
Most physicians feel that the effort to manage multiple conditions
and medications is the main reason why oral anticoagulant
patients experience difficulties with their regimen.
There is room for improvement in communication by physicians
about oral anticoagulant regimen requirements and blood test
results.
Physicians could be doing more to help their patients with ongoing
management of their oral anticoagulant regimen.
Improving blood testing, communication, and involvement with
health care professionals are seen as key components in helping
patients comply with their oral anticoagulant regimen.
11
Executive Summary
12
Three Key Themes Across Groups
1. Oral anticoagulant use presents a challenge to
patients, caregivers, and physicians.
2. There are gaps in education around oral
anticoagulant use, both for patients and caregivers.
3. There are gaps in the health care management of
oral anticoagulant patients.
13
Key Theme #1
Oral anticoagulant use presents a challenge
to patients, caregivers and physicians.
14
Patients on oral anticoagulant medications have
complicated health needs, use numerous medications,
and see multiple doctors.
•
•
•
•
3 in 5 suffer poor or fair health
Most suffer four or more conditions
Almost all take multiple medications, and many take OTCs
Almost all see multiple doctors, with 2 in 5 seeing 4 or more
doctors
• Half of patients have been hospitalized or have gone to the ER
past 12 months
• Generally, caregivers report even greater health management
challenges among their family members
• Most caregivers care for someone memory impairment
15
3 in 5 oral anticoagulant users suffer poor or fair
health.
How would you describe your own health?
59%
Caregiver response
in contrast:
Fair/Poor: 69%
39%
32%
20%
9%
0%
Excellent
Q310
Base:
Very Good
Good
Fair
Poor
In general, how would you describe your own health?
Qualified respondents (n=426)
16
More than half of oral anticoagulant users suffer four or more
of these conditions.
Diagnosed with:
%
Any of these conditions
92
Four or more of these conditions
54
Hypertension, sometimes called high blood pressure
66
Heart disease, including heart attack
60
Atrial Fibrillation also known as “Afib”
51
Arthritis
47
Stroke or stroke-like symptoms
38
Diabetes
35
Depression
23
Blood clot, thromboembolism or pulmonary embolism
22
Heart valve replacement
20
Asthma, Emphysema, or any other chronic lung problems
19
A high red blood cell count (polycythemia)
2
Sickle cell anemia
*
Q335
Have
you been toldreporting
by a doctor that
you their
have . .family
.?
In contrast:
Caregivers
that
member suffers from four or
Base: Qualified respondents (n= 426)
more *ofLess
these
than 1 conditions
percent
43
17
Most oral anticoagulant patients are taking
multiple prescription medications and OTCs.
Rx and OTC Use:
%
Number of prescription medications taken on regular basis:
1 (anticoagulant only)
2
2-4
23
5-7
35
8 or more
38
Mean number of Rx: 7
Currently taking Plavix on a regular basis
6
Currently taking aspirin as a blood thinner
37
Currently taking any OTCs on regular basis (not including aspirin)
27
Currently taking vitamins or supplements on a regular basis
46
Q500
Q507
Q510
Q512
Q508
Base:
Including your blood thinning medication, how many different prescription medications do you take on a regular or ongoing basis?
In addition to anticoagulant, are you also taking Plavix on a regular basis?
Are you taking any over-the-counter medications such as aspirin, Motrin, Tylenol, Tagamet, or Zantac, on a regular or ongoing basis?
Are you taking any vitamins or supplements, such as ginkgo, ginseng or St. John’s Wort, on a regular or ongoing basis?
Are you taking aspirin as a blood thinning medication?
Qualified respondents (n=426)
18
Oral anticoagulant users see multiple
doctors, in addition to their regular doctor.
In the past year, number of doctors seen in addition to regular doctor;
41%
18%
20%
14%
14%
16%
11%
6%
Regular
doctor only
1
2
3
4
5
6 or more
Caregiver responses in contrast:
65% of their family members see for
4 or more doctors
Q410
Base:
In addition to your regular doctor, how many other doctors, including specialists, have you seen in the past year?
Qualified respondents (n= 426)
19
Most caregivers are caring for someone with memory
impairment.
Severe Memory
Impairment
4%
Moderate Memory
Impairment
68%
29%
35%
Mild Memory Impairment
No Memory Impairment
32%
Q820 Does your family member suffer from memory impairment? If so, how severe is this impairment?
Base: Qualified respondents (n=109)
20
Following the oral anticoagulant
treatment regimen is difficult for many.
•
A substantial minority of patients are less than very confident
that they are taking the oral anticoagulant medication correctly.
• 1 in 5 caregivers are less than very confident that their family
member is taking the medication correctly. Assistance with
following treatment recommendations is needed.
• 2 in 5 caregivers feel that family members need encouragement
to follow recommendations. A small minority needs a great deal
of encouragement (8%).
• Physicians report that patient non-compliance with medication
regimen and recommended blood tests are the top challenges
to treating anticoagulant patients.
• Physicians indicate that nearly half of patients are managing
their anticoagulant regimen less than very well. They report that
1 in 4 patients have a difficult time following the
recommendations.
21
A substantial minority of patients are less than very
confident that they are taking the oral anticoagulant
correctly.
Confidence that they are taking anticoagulant medication the correct way
17%
46%
37%
12%
Extremely
Confident
Very Confident Fairly Confident
4%
1%
Somewhat
Confident
Not At All
Confident
Q645 Overall, how confident are you that you are taking the anticoagulant the correct way to ensure that the drug works at its best and does not cause
any problems?
Base:
Qualified respondents (n=426)
22
Nearly 1 in 4 caregivers are less than very confident that their
family members are taking the oral anticoagulant medication
correctly.
22%
39%
39%
17%
4%
Extremely confident
Very Confident
Fairly confident
Somewhat confident
1%
Not at all confident
Q530 Overall, how confident are you that you family member is taking his/her oral anticoagulant medication the correct way?
Base: Qualified respondents (n=109)
23
Patients recognize the importance of safe
behaviors; Compliance is more difficult.
Importance of and compliance with anticoagulant precautions
Tell all doctors that they are taking an
anticoagulant
96%
90%
Have their blood tested as often as
recommended
96%
80%
Tell dentist that they are on anticoagulant
before dental work
95%
84%
80%
Talk to doctor/pharmacist before taking OTCs
46%
Tell pharmacist that they are taking an
anticoagulant
Follow a consistent diet
78%
49%
62%
19%
Believe that behavior is extremely or very important
Always comply with behavior
Q640
Q610
Base:
As far as you know, how important is it for people who take anticoagulants to . . . ?
How often do you do the following?
Qualified respondents (n=426)
24
Following an appropriate diet is difficult for many
patients.
Eat a diet appropriate for somebody who takes an
anticoagulant
27%
Avoid taking OTCs w/o first checking with
doctor/pharmacist
10%
Avoid taking supplements/vitamins without first
checking with doctor/pharmacist
8%
Avoid taking other Rx medications without first
checking with doctor/pharmacist
7%
See doctor about blood levels on a regular basis
7%
Get blood tested on a regular basis
Remember to tell other doctors/dentists that you are
on anticoagulant
Remember to take anticoagulant
6%
2%
Finds it very or
somewhat difficult
to…
1%
Q910 How easy or difficult is it for you to . . . ?”
Base: All respondents (n=426)
25
2 in 5 of caregivers feel that family members need at least
some encouragement to follow instructions associated with
taking the anticoagulant medication safely
A Great Deal of
Encouragement
needed
8%
40%
Some
Encouragement
needed
32%
Very little
Encouragement
needed
No Encouragement
needed
38%
22%
Q520 How much encouragement does you family member need to follow all o the instructions associated with taking an oral
anticoagulant medication?
Base: Qualified respondents (n=109)
26
Most caregivers report that their family members need at least
some assistance following recommendations.
Eat a diet appropriate for somebody who takes an
anticoagulant
39%
Check doctor/pharmacist for possible interactions OTC and
vitamins
Check doctor/pharmacist for possible interactions with other
Rx drugs
Follow all of his/her doctor's recommendations related to taking
the oral anticoagulant medication
Get his/her blood tested regularly
41%
39%
32%
29%
Read info about drug provided by pharmacy
29%
Tell other doctors/dentist that patient is taking drug
32%
Understand blood test results
31%
Needs some assistance
12%
29%
Needs a great deal of assistance
63%
60%
18%
59%
19%
10%
8%
64%
22%
12%
6%
67%
17%
9%
10%
69%
17%
19%
9%
58%
16%
17%
14%
70%
17%
11%
36%
Keep up with prescribed changes in dosage
Remember to take drug
15%
54%
51%
Completely depends on others
Q510 How much assistance does your family member need to follow these recommendations related to taking his/her anticoagulant?
Base: Qualified respondents (n=109)
27
Physicians feel that patient non-compliance with medication
regimen and recommended blood tests are the top challenges
when dealing with oral anticoagulant patients.
Percent who indicated items as one of top 3 challenges
48%
Patients not being compliant with the medication regimen
46%
Patients not getting their blood tested as directed
39%
Interactions with drugs prescribed by other physicians
30%
Patients not returning for follow-up visits
27%
Patients not following a consistent diet
26%
Patients taking OTCs that they should avoid
16%
Problems getting lab results
Problems resulting from use of generic versions
15%
Pharmacies that change the supplier of their generic versions
15%
11%
Patients not reporting symptoms or complications
Problems reaching or communicating with pharmacists about patients
None of these
4%
2%
Q610 Thinking about your experiences managing patients who take oral anticoagulants, which would you say are the biggest challenges you face?
Base: Qualified Respondents (n=101)
28
Physicians report that almost half of patients are
managing their anticoagulant regimen less than very
well (Case Study)
Percent of physicians indicating how well the patient is managing oral anticoagulant use:
19%
Extremely well
33%
Very well
31%
Fairly well
15%
Somewhat well
Not at all well
Not sure
2%
1%
Q555 Overall, how well do you think this patient is managing his/her oral anticoagulant?
Base: Qualified Respondents (n=101)
48%
29
Physicians report that 1 in 4 patients have difficulty
following recommendations (Case Study)
Percent of physicians indicating how difficult it is for the patient to follow all of their recommendations:
Very easy
29%
Somewhat easy
45%
Somewhat
difficult
Very difficult
Not sure
24%
2%
26%
1%
Q560 To the best of your knowledge, how easy or difficult is it for this patient to follow all of your recommendations related to taking his/her oral
anticoagulant?
Base: Qualified Respondents (n=101)
30
Adverse reactions due to oral anticoagulant use are
not uncommon. Many patients do not change their
behavior or seek help.
• Almost all patients have experienced at least one side
effect to the anticoagulant medication.
• A troubling minority have been to the ER and/or the
hospital because of problems related to their medication.
• Only about 2 in 5 patients contacted their doctor in
response to a problem.
• Only about half say that they did anything to change their
behavior in response to a problem.
• A majority of physicians report that, in the past 12 months,
they have had anticoagulant patients who called or visited
the office and/or went to the ER or hospital due to
problems with their medication.
31
Most patients have experienced adverse reactions to
oral anticoagulant use.
Ever experienced any of these adverse reactions as a result of taking their anticoagulant
Any of these (Net)
93%
82%
Easy bruising
Bleeding that would not stop from a cut
54%
Dizziness
48%
Nose bleeds or bleeding gums
46%
Bloated stomach or gas or stomach cramps
46%
Skin rashes
Q615
27%
Nausea or vomiting
21%
Internal bleeding
20%
Note: Percentages shown are the
sum of responses ‘always’, ‘most
of the time’, ‘sometimes’, and
‘rarely’.
How often, if at all, do you experience any of the following as a result of taking the anticoagulant?
Base: All respondents (n=426)
32
A troubling minority of patients have been to the hospital
or emergency room because of problems with their oral
anticoagulant.
No hospital/ER use due to
anticoagulant:
92%
Went to ER due to
anticoagulant problem:
5%
8%
Q630
Base:
Admitted to hospital due to
anticoagulant problem:
3%
Caregiver responses in contrast:
11% say their family member went
to the ER or hospital due to
anticoagulant problem
In the past 12 months, have you gone to the emergency room or been admitted to the hospital because of a problem related to taking
the anticoagulant.
Qualified respondents (n=426) [NOTE: RECALCULATED TO BASE OF ALL QUALIFIED RESPONDENTS]
33
Half of patients who experience adverse
reactions do nothing to change their behavior.
Change in behavior after experiencing side effects from anticoagulant use
51%
7%
11%
6%
Changed/
More careful/
monitored diet Avoid cuts and
bruises
6%
5%
Adjusted
dosage
Made lifestyle
changes*
Other
Did nothing/ No
changes
*Lifestyle changes: test regularly, changed/added
medications, monitored health status, etc.
Q635
Base:
After you have experienced side effects or other adverse reactions due to taking anticoagulant, what, if anything, are you doing differently
now?
Qualified respondents who experienced at least 1 side effect (n=395)
34
Many patients who experience adverse reactions do not
contact their doctor about the problem.
Response to experiencing side effects from anticoagulant use
41%
37%
22%
9%
6%
3%
Telephoned
doctor
Q620
Base:
Went to see
doctor
Went to ER
Admitted to
hospital
Nothing
Not sure
What did you do when you experienced side effects from taking anticoagulant? Please select all that apply.
Qualified respondents who experienced at least 1 side effect (n=395)
35
Most physicians have anticoagulant patients who contact them
with problems due to their anticoagulant use; Half have
patients who end up in the ER or hospital.
Called the office
84%
Visited the office
82%
Went to ER
52%
Went to hospital
None of these
51%
7%
Q440 In the past 12 months, have any of your patients done any of the following because of a problem related to taking their oral anticoagulant
medication?
Base:
Qualified respondents (n=101)
36
Caregivers struggle to help manage the complex
care needs of their loved ones.
• Many oral anticoagulant users have family members or friends
assisting with their care, physicians report that more than 1 in 3
new anticoagulant patients are accompanied by a caregiver
• Caregivers are involved in a multitude of aspects related to their
family members anticoagulant regimen, from accompanying
them to the doctor to keeping track of all their medication
• Many of these caregivers feel that it is their responsibility to
ensure that their family member takes their anticoagulant
medication as prescribed
• Many caregivers find it difficult to assist with the oral
anticoagulant regimen
37
According to physicians, 1 patient in 3 was accompanied
by a caregiver when their oral anticoagulant treatment
was initiated.
Physician reports of proportion of patients with caregiver at initial appointment
<5%
4%
9%
11 - 25%
27%
2%
31 - 40%
12%
13%
51 - 60%
7%
11%
71 - 80%
5%
34%
5%
91 - 100%
5%
4%: Decline to answer
Q413B Proportion of patients who come to initial consultation for anticoagulant medication with a caretaker.
Base:
Respondents who have 5 or more patients on oral anticoagulants (n=94)
38
Caregivers are involved in all aspects of anticoagulant
management.
Tasks:
%
Go with family member to the doctor who prescribes his/her oral
anticoagulant medication
82
Help family member keep track of ALL of the medications that he/she is
taking, including prescription drugs, OTC drugs, vitamins, and
supplements
80
Pick up prescriptions for anticoagulant medications
76
Find out results of the blood tests (eg. INR level) that are part of family
member’s regimen
74
Help monitor family member’s diet
68
Go with family member to have his/her blood tested as part of his/her
regimen
64
Remind family member about the special things he/she needs to be careful
about when taking his/her oral anticoagulant medication
57
Remind family member to take his/her oral anticoagulant medication
55
Assist with self-testing of blood to determine INR level
15
Q340 Do you assist your family member in any of the following ways?
Base Qualified respondents (n=109)
39
2 in 5 caregivers feel that they are primarily responsible for
ensuring that their family member takes the oral anticoagulant
correctly.
Percent of caregivers identifying who is primarily responsible for ensuring that family member
follows recommendations:
Family member himself/herself
55%
Me, as his/her caregiver
39%
His/Her nurse
His/Her doctor
Someone else
Another family member
3%
2%
1%
0%
His/Her pharmacist 0%
Not sure 0%
Patient responses in contrast:
Patient himself/herself
Doctor
Spouse or Caretaker
Pharmacist
Nurse
82%
11%
3%
2%
2%
Q630 Who do you think is primarily responsible for ensuring that your family member takes his/her oral anticoagulant medication as prescribed and
follow all of the recommended actions related to taking this medication?
Base: Qualified respondents (n=109)
40
Many caregivers find it at least somewhat difficult to assist with
their family member’s oral anticoagulant regimen.
Percent of caregivers finding it very difficult or somewhat difficult to…
Keep track of multiple prescription medications
24%
Keep family member motivated to follow the anticoagulant
regimen
15%
Remember all special things to do while taking anticoagulant
12%
Assist family member with getting blood tested regularly
10%
Getting blood test results in timely matter
8%
Getting clear explanation of blood test results
8%
Getting doctor's appointments
Keeping track of when blood tests need to be done
6%
5%
Q700 How difficult or easy do you find the following when assisting your family member managing his/her use of oral anticoagulant
medication?
Base Qualified respondents (n=109)
41
Physicians see care for oral anticoagulant patients
as a challenge, requiring more time than patients
with other chronic conditions
• According to physicians, oral anticoagulant patients require
more time than other patients with other chronic diseases.
• The average anticoagulant patient visits the doctor 7 times a
year, with more than 1 in 5 making 10 or more visits a year
42
Anticoagulant patients require more of physicians’
time than other chronically ill patients.
Time anticoagulant patients require:
Much less
time
%
Somewhat
less time
%
About
the same
amount
of time
%
Amount of time adjusting medication
1
3
17
The amount of time I need to review
and relay their test results
-
5
The amount of time I have to spend
with the patient (both in person and
on phone/email consultations)
-
The amount of time that other staff in
my practice need to spend with the
patients
-
Somewhat
more
time
%
Much
more
time
%
Net of
more
time
%
51
28
79
26
48
22
69
6
27
53
14
67
4
34
39
22
60
Q605 Compared to your patients on other medications for other chronic conditions (such as diabetes, arthritis, chronic lung disease, heart condition, or
high blood pressure), do you find that your oral anticoagulant patients require more or less time from you or your staff for the following activities?
43
Base: Qualified Respondents (n=101)
According to physicians, the average anticoagulant
patient visits the doctor 7 times a year (Case Study)
Percent of physicians who report the number of times they have seen their most recent
anticoagulant patient in the past year:
1
2%
2
11%
3
19%
4
16%
5
16%
6
15%
7
5%
8
5%
9 0%
10
11
12
More than 12
Q531
Average number of visits a year: 7
5%
1%
6%
8%
Not sure: 2%
How many times have you seen this patient in the past year? If you are not sure, your best estimate will do.
Base: Qualified Respondents (n=101)
44
Key Theme #2
There are gaps in education around oral
anticoagulant use, both for patients and caregivers.
45
Need for greater education, particularly around dietary
considerations, drug interactions, and side effects.
• While most patients and caregivers recognize the importance of
following the precautions, there are some gaps in knowledge,
particularly around dietary concerns, potential interactions, and
side effects.
• Troubling minorities of patients report that their doctor did not tell
them about important elements of their anticoagulant regimen.
• Many physicians also admit that they do not tell all their patients
this important information when they first start them on
anticoagulant medication. Opportunities for education at
initiation of treatment are being lost.
46
Patients recognize the importance of safe
behaviors, with some weaker areas.
Importance of anticoagulant precautions
Tell all doctors that they are taking an
anticoagulant
96%
Have their blood tested as often as
recommended
96%
Tell dentist that they are on anticoagulant before
dental work
95%
Talk to doctor/pharmacist before taking OTCs
80%
Tell pharmacist that they are taking an
anticoagulant
Follow a consistent diet
78%
62%
Believe that behavior is extremely or very important
Q640
Base:
As far as you know, how important is it for people who take anticoagulants to . . . ?
Qualified respondents (n=426)
47
There are some gaps in caregiver knowledge about dietary
concerns, potential interactions, and side effects.
Percent of caregivers who have no understanding or are unsure:
Special dietary considerations
25%
Potential interactions between oral anticoagulants and
other prescriptions and OTC medicaitons
21%
Side effects
13%
How often he/she needs to have blood tested
Why he/she needs oral anticoagulant
9%
4%
Q500: Regarding your family member’s use of their oral anticoagulant, do you understand the following…?
Base: Qualified respondents (n=109).
48
A small but troubling minority of caregivers have had problems
with a lack of information or conflicting information.
Not enough information about the things he/she
is supposed to do when taking an oral
anticoagulant
14%
Conflicting information about what he/she is
suppose to do when taking an oral anticoagulant
Not enough counseling and support from health
care professionals to keep compliant with the
regimen
10%
9%
Considering it a big problem or somewhat of a problem
Q710 How much of a problem has each of the following been for your or your family member?
Base: Qualified respondents (n=109)
49
There are gaps in education of new oral anticoagulant
patients.
When your doctor first prescribed your anticoagulant, did he or she:
Yes
%
No
%
Not Sure
%
Tell you about any special dietary considerations you should know
while taking this medication
74
21
5
Explain potential interactions between the anticoagulant and other
prescription or over-the-counter medication, vitamins or supplements
76
19
5
Explain any side effects you might experience when taking the
anticoagulant
78
17
5
Tell you symptoms to watch for and when to seek further care or
treatment
79
15
6
Give you clear instructions about how to take the medication
94
4
1
Tell you how often you should have your blood tested
96
2
1
Explain to you why you need to take the anticoagulant
98
1
1
Q520
Base:
Thinking about the first time when the doctor prescribed the anticoagulant for you, did he or she. . .?
Qualified respondents (n=426)
50
Many physicians do not tell their patients important information
when they first start patients on and anticoagulant medication.
Less than
every time
%
Every time
%
Tell them about any special dietary considerations they should know
while taking this medication
44
47
Explain potential interactions between the oral anticoagulant and other
prescription or over-the-counter medications, vitamins or supplements
42
59
Explain any side effects they may experience
34
66
Tell them about symptoms to watch for and when to seek further care or
treatment
28
74
Give them specific instructions about how to take the medication
28
72
Tell them about how often they should have their blood tested
20
80
Explain why they need to take it
15
85
Advise them to wear a medical information emblem (bracelet or identifier)
or carry a piece of paper that indicates the name of their anticoagulant
medication
83
16
Issues that doctors talk about when initiating oral anticoagulant
medication for the first time:
Q402
First, please think about the situations when you start a patient on an oral anticoagulant or when you see a patient immediately after he or
she has been started on an oral anticoagulant in a hospital. In these situations, how often do you talk to your patients about the following issues when
you give them an oral anticoagulant prescription for the first time.
Base:
Qualified respondents (n=101)
*1% not sure
51
Key Theme #3
There are gaps in the health care
management of oral anticoagulant patients.
52
Improvement is needed in communication
between doctors and patients about the
management of their treatment regimen.
• Many physicians do not always contact patients with reminders
about blood test results, appointments, or to check on health
status.
• Patients and physicians do a good job managing multiple
prescriptions; Could improve management of OTCs.
• During physician visits, many patients are not being asked about
compliance, problems they may be having, and diet.
• Serious gaps in the management of and communication around
blood testing.
53
Good communication and information are seen by physicians
as most effective in increasing patients’ compliance with oral
anticoagulant medication.
Very
Effective
%
Extremely effective
%
Net
4/5
%
29
21
50
Improving communication about blood results – consistent
feedback loop, regardless of whether INR results are good
or bad
42
18
59
Better information available to patients about what they
should or should not do
33
18
50
Having more patients visit anticoagulant clinics for routine
care
31
16
47
Nurses or other health-care professionals providing ongoing
disease management for patients
37
15
51
Physicians spending more time with patients to provide
counseling and support
41
11
51
Providing rewards to patients who show perfect compliance
with their medication regimen
24
11
35
Patient self-testing their blood for INR level
26
9
35
Pharmacists spending more time educating and counseling
patients
26
7
33
Physician ratings of the following approaches:
Improve the speed and accuracy of blood testing
Q620 How effective do you think the following approaches to increasing patient oral anticoagulant compliance would be?
Base: Qualified Respondents (n=101)
54
The majority of physician offices do not contact their patients
every time to remind them about their next appointment or to
have their blood tested.
Every time
%
Less than
every
time
%
Remind them of their next appointment
43
56
Remind them to have their blood tested
45
55
To check how well they are doing
21
76
Follow-up contact
Q416 How often, if ever, do you or your office staff contact your oral anticoagulant patients to….?
Base:
Qualified respondents (n=101)
55
Patients and physicians do a good job managing multiple
prescriptions; Could improve management of OTCs.
Yes
%
No
%
Not Sure
%
In the past year, has a doctor, nurse, or other health care
professional reviewed with you all of the prescription
medication you take
96
4
*
Do all of the doctors you see know that you are taking an
anticoagulant
98
1
1
Does your doctor know you are taking OTCs, vitamins, or
supplements in addition to the anticoagulant
87
5
7**
Medication management:
Q505
In the past year, have any of the following people reviewed with you all of the prescription drugs you are taking?
Q440
Do all of the doctors you see know that you are taking the anticoagulant?
Base:
Base:
Q515
Respondents taking more than one prescription medication (n=424)
Respondents seeing more than one doctor (n=398)
Does the doctor who prescribes your anticoagulant know that you are taking these over-the-counter medications, vitamins, or supplements?
Base: Respondents who take OTCs/Vitamins (n=323)
•Less than 1 percent
** Includes decline to answer (2%)
56
While physicians are doing well with reviewing
medication, many patients are not being asked about
compliance, problems, and diet. (Case Study)
On this patient’s most recent visit did you…?
Yes
%
No
%
Not sure
%
Review the patient’s latest blood test results
96
4
-
Review all of the patient’s medications, including over-thecounter medications, vitamins and supplements
84
14
2
Ask the patient whether he/she is taking the oral anticoagulant as
prescribed
83
17
-
Ask the patient whether he/she is having any problems related to
taking the oral anticoagulant
79
20
1
Ask the patient about his/her diet
50
49
1
Q529
Base:
On this patient’s most recent visit did you…?
Qualified respondents (n=101)
57
There are considerable gaps in knowledge and
communication about the blood test goals.
Blood test goals:
Yes
%
No
%
Not Sure
%
Has a health care professional ever told you
what your “number” should be?
79
14
7
Does you number usually stay in the desired
range?
61
33*
7
*includes respondents saying “it fluctuates”
Q830
Q840
Base:
Has a health care professional ever told you what your “number” should be?
Does your ”number” usually stay within the desired range?
Qualified respondents (n=426)
58
Many patients do not know their latest PT/INR
number.
PT/INR number last time they had their blood tested
0.1 - 0.9
1%
1.0 - 1.9
9%
2.0 - 2.9
41%
3.0 - 3.9
4.0 - 4.9
5.0+
12%
2%
3%
Not Sure
28%
4%: Decline to answer
Q835
Base:
What was your “number” when you were last tested?
Respondents who were told of INR (n=426)
59
Many patients are not always getting clear
and timely feedback about blood test results.
Contacting about blood test results:
%
Frequency of contact about blood test results:
Every time
83
Less than always (NET)
17
(Usually 12%; Rarely/Never 5%)
The last time he/she had their blood tested:
Results were not explained/Respondent was not contacted
5
Results were explained, but not clearly
6
Of those who are not contacted about blood tests, frequency of
contacting the doctors’ office oneself:
Every time
18
Less than always (NET)
82
(Usually 33%; Rarely/Never 49%)
Q815
After having a blood test, how often, if ever, does someone contact you to give you your blood test results?
Q825
Base:
Q818
Last time you had your blood tested, did someone explain the results in a way that you could understand?
Base:
Base:
Qualified respondents who get blood checked (n=419)
Qualified respondents who get blood checked (n=419)
If nobody from your doctor’s office contacts you to give you your blood test results, do you usually contact the doctor’s office yourself?
Qualified respondents who do not get contacted every time (n=73) [NOTE: SMALL BASE]
60
One in four physicians do not always call or mail the
patients to inform them about their INR test results.
I or someone else in my office always call patients with
INR results.
67%
I or someone in my office call patients with INR results,
but only when there is a change in the numbers.
My office always mails a letter to patients with INR
results.
My office mails a letter with INR results, but only when
there is a change in the numbers.
My office generally does not contact the patient with INR
results.
22%
5%
2%
1%
None of these describe my office’s approach to
contacting patients with INR results.
Not sure
Q425
8%
0%
Which of the following best describes your office’s general approach to contacting patients regarding their INR results?
Base: Qualified Respondents (n=101).
Note: Multiple responses question, respondents could say that they phone and send letters.
61
When informing their patients about their INR test results,
many physicians do not tell their patients their actual
numeric INR value.
Tell them the actual
numeric INR value
53%
Describe the blood
characteristics (e.g.,
too thick or too thin)
31%
Describe the results in
terms of “good” or
“bad”
Other
11%
5%
Q435
What terminology do you generally use to describe INR test results to your oral anticoagulation patients?
Base: Qualified Respondents (n=101)
62
Caregivers also need better ongoing communication
with physicians to help assist patients manage their
treatment.
• Many caregivers find it difficult to speak to their family members’
doctor.
• Caregivers see areas for improvement in communication
between themselves and their family members doctor,
particularly around education about treatment requirements.
63
Many caregivers find it difficult to speak with somebody in the
doctor’s office when they have questions about the use of the
anticoagulant; Pharmacists are more accessible.
How easy or difficult is it for you to…
Speak with
his/her doctor or
someone in the
doctor's office
Reach a
pharmasist
23%
8%
Very Difficult/Somewhat Difficult
Q620 When you or your family member have questions about the use of anticoagulant, how difficult or easy is it to reach someone at his/her doctor’s
office who can answer questions about the use of the anticoagulant?
Q625 When you or your family member have questions about the use of the anticoagulant, how difficult or easy is it to reach a pharmacist who can answer
questions about the use of the anticoagulant?
Base: Qualified respondents (n=109)
64
Caregivers see areas for improvement in communication with
their family members’ physician.
Explaining to your loved one all of the things he/she
needs to know to effectively take the oral
anticoagulant medication
24%
Explaining to you all the things need to know as a
caregiver
23%
Being responsive to questions about the medication
19%
Being responsive to questions about being an
effective caregiver
19%
Explaing the importance of the medication
18%
Rate their family member's physician less than very good
Q610 How would you rate your family member’s physician on each o the following criteria?
Base: Qualified respondents (n=109)
65
Assistance is needed to remain compliant with
treatment requirements and goals. Caregivers need
assistance in helping their loved ones to do so.
• 2 in 5 patients do not have the assistance of a health
care professional, in addition to their doctor, to help
them manage their blood thinning medication.
• Almost 2 in 5 physicians do not have a nurse or other
health care professional in their office to help patients
manage their oral anticoagulant.
• Many patients and caregivers do not receive written
instructions about all of the things they need to do
when taking an oral anticoagulant.
• Better health care management is associated with
improved awareness, behavior, and confidence
around the management of oral anticoagulant use.
66
2 in 5 respondents do not have an additional health care
professional to help manage oral anticoagulant use.
% indicating another health care professional, in addition to their doctor, helps manage anticoagulant
58%
41%
31%
25%
9%
1%
A Nurse
A Pharmacist
Some other health
care professional
No
Not sure
Note: Multiple responses allowed
Q435
Base:
In addition to the doctor who prescribes your blood thinning medication, is there a nurse, a pharmacist or another health care
professional who helps you manage your blood thinning medication?
Qualified respondents (n=426)
67
Nearly 2 in 5 physicians do not have a nurse or other health
care professional in their office to help patients manage their
oral anticoagulant.
Yes, a nurse
Yes, another healthcare professional
No
46%
18%
37%
Q410 Is there a nurse or another health-care professional in your office who helps patients manage their oral anticoagulant? This may include calling
them regularly to check how well they are doing, reminding them about appointments for blood testing, reviewing their blood test results with them,
etc. Please do not include a receptionist calling the patient about appointments.
Base: Qualified respondents (n=101)
68
Most caregivers feel they would benefit from having someone in
the doctor’s office they could call for information. Other
solutions could also be of help.
A nurse or other healthcare professional in the doctor's
office who could be called for information
Someone at the doctor's office giving information about
what to do
More and better information about the things he/she is
suppose to do when on medication
Pharmacist giving more education about medication
Healthcare professional who checks in regularly with
the caregiver and patient
Would benefit somewhat
34%
36%
28%
67%
31%
39%
37%
72%
38%
26%
24%
32%
65%
61%
61%
Would benefit a great deal
Q720 How much do you think you and your family member would benefit from the following supports to help you manage your oral
anticoagulant use?
Base Qualified respondents (n=109)
69
Written communication is seen by many physicians as
a good method of relaying information.
25%
Give written guidelines/handouts
18%
Regular counseling/checkups
14%
Keep doctor informed about any changes/problems
12%
Clearly state goals/risks of taking anticoagulant
11%
Watch the diet
10%
Check with physician before taking other medications or OTCs
9%
Regular blood tests
7%
Take medication as directed
Help them understand INR test results
5%
Face-to-face communication
5%
Raise awareness of bleeding
4%
Done by hospital/clinic
4%
18%
Other
9%
Nothing
Don’t know/ not sure
3%
Q705 Please specify any particularly good methods you use or are aware of to communicate to your patients the “rules and guidelines” they should
follow because they are on an oral anticoagulant therapy.
Base: All respondents (n=101)
70
Just over half of patients received written instructions
about taking the oral anticoagulant.
Did not receive written
instructions:
40%
Received written
instructions:
55%
Caregiver responses in contrast:
24% did not receive written
instructions
64% received written instructions
12% were not sure
Q528
Base:
Not sure:
5%
Has a doctor, nurse or other health care professional ever prepared for you written instructions about taking the anticoagulant, including
what you should and should not do , such as following a specific diet, not taking certain prescription and over-the-country medications,
getting your blood test regularly, etc.? Please do not include being given an informational insert that comes with your medication or from
the drug maker.
Qualified respondents (n=426)
71
1 in 3 physicians does not provide any of their oral
anticoagulant patients with written instructions.
Yes, give written
instructions to all
patients taking an
anticoagulant
Yes, give written
instructions to some
patients taking an
anticoagulant
No, do not give written
instructions
38%
31%
32%
Q407 Do you or does someone else in your office give written instructions about taking anticoagulant medications to your patients? These written
instructions may inform patients about what they should and should not do with regard to diet, concomitant prescription and over-the-counter
medication use, blood tests , etc. Please do not include the informational insert that comes with the medication or from the drug maker.
Base:
Qualified respondents (n=101)
72
Patients with access to another health care professional
have better management of blood testing.
Access to Another
Health Care Professional
Yes
%
No
%
Always
60
40
Never
20
39
Were told what PT/INR “number” should be
84
73
Knows what PT/INR number was the last time they were tested
76
56
Every time
86
77
Less than always (NET)
13
23
91
85
Managing blood testing:
Frequency of reminders about blood testing:
Frequency of contact about blood test results:
The last time he/she had blood tested, results were explained clearly
Q815
Q825
Base:
Q830
Q835
After having a blood test, how often, if ever, does someone contact you to give you your blood test results?
Last time you had your blood tested, did someone explain the results in a way that you could understand?
Qualified respondents who get blood checked (n=419)
Has a health care professional ever told you what your “number” should be? Base: Qualified respondents (n=426)
What was your number when you were lasted tested? Base: Respondents who were told of INR (n=338)
73
Health Care Management Score
Health care management score
%
Have a health care professional, in addition to the doctor, helping to manage oral
anticoagulant use (1 point)
58
The first time doctor prescribed the oral anticoagulant, did he/she…. (% yes)
Explain to you why you need to take anticoagulant
98
Tell you how often you should have your blood tested
96
Give you clear instructions about how to take the medication
94
Tell you about symptoms to watch for and when to seek further care
79
Explain any side effects you might experience
78
Explain potential interactions between anticoagulant and other Rx or OTC
76
Tell you about any special dietary considerations
74
Received ALL of the above (1 point)
37
Patient was provided written instructions about anticoagulant precautions (1 point)
55
The last time he/she had blood tested, results were explained clearly (1 point)
88
Health Care Management Score (total of 4 points)
Poor/Fair health care management (0-2 point)
43
Good health care management (3-4 points)
57
74
Patients with better health care management are more
aware of the importance of oral anticoagulant precautions.
% who believe that behavior is extremely or very important
Tell all doctors that they are taking an
anticoagulant
94%
98%
Have their blood tested as often as
recommended
91%
Tell dentist that they are on anticoagulant
before dental work
92%
99%
97%
66%
Talk to doctor/pharmacist before taking OTCs
90%
Tell pharmacist that they are taking an
anticoagulant
66%
87%
44%
Follow a consistent diet
Poor/Fair health care management
Q640
Base:
76%
Good health care management
As far as you know, how important is it for people who take anticoagulants] to . . . ?
Qualified respondents (n=426)
75
Patients with better health care management are more
compliant with oral anticoagulant precautions.
% who indicate they always do the following…
Tell all doctors that they are taking an
anticoagulant
86%
93%
Have their blood tested as often as
recommended
72%
87%
Tell dentist that they are on anticoagulant
before dental work
77%
90%
30%
Talk to doctor/pharmacist before taking OTCs
57%
Tell pharmacist that they are taking an
anticoagulant
Follow a consistent diet
Poor/Fair health care management
Q610
Base:
How often do you do the following?
Qualified respondents (n=426)
35%
59%
6%
29%
Good health care management
76
Patients with better health care management are more
confident that they are taking the medication correctly.
Confidence that they are taking anticoagulant medication the correct way
57%
43%
33%
32%
16%
8%
Extremely
Confident
Very Confident
Fairly Confident
Poor/Fair health care management
7%
2%
Somewhat
Confident
2%
1%
Not At All
Confident
Good health care management
Q645 Overall, how confident are you that you are taking the anticoagulant the correct way to ensure that the drug works at its best and does not cause
any problems?
Base:
Qualified respondents (n=426)
77
Patients with better health care management find it easier to
follow the precautions of oral anticoagulant use.
% indicating it is very easy to follow the following precautions…
Remember to take the anticoagulant
83%
87%
Remember to tell doctors/dentists about anticoagulant use
82%
88%
70%
Get blood tested regularly
81%
64%
Avoid taking Rx without checking with doctor/pharmacist
77%
59%
See doctor about blood levels
70%
Avoid taking vitamins/supplements without checking with
doctor/pharmacist
57%
70%
48%
Avoid taking OTCs without checking with doctor/pharmacist
Eat an appropriate diet
Poor/Fair health care management
Q910
Base:
How easy or difficult is it for you to…
Qualified respondents (n=426)
63%
25%
38%
Good health care management
78
Preliminary Conclusions
79
Education, ongoing communication, and assistance with
health care management are key to improving oral
anticoagulant treatment.
•
•
•
•
•
•
It is important to strengthen the education provided by physicians
(and/or nurses in physician offices), both at the time of first prescription
and ongoing.
Doctors are the first line of education, but nurses, pharmacists and
other health professionals can take on some of the burden.
Patients and caregivers need more resources for information and
counseling. Pharmacists and designated nurses at physician offices
could be important resources.
Written information about the precautions associated with anticoagulant
use would be a simple and effective educational tool, yet many patients
do not receive this.
Educating patients about the importance of blood testing and the
meaning of blood test results is key to improving compliance and
positive outcomes.
Caregivers need to be educated and recognized for their role in
provision of care for anticoagulant patients. Physicians, nurses,
pharmacists and other health care professionals involved in patient’s
care need to be accessible to caregivers.
80