Impact of Medication Therapy Management on Patient Knowledge and Adherence in Oral Anticoagulant Use.

BACKGROUND: The deficiencies in patient knowledge and adherence constitute a significant obstacle to optimal utilisation of oral anticoagulants, resulting in diminished safety and effectiveness. AIM: The aim of the study was to assess the impact of pharmacist-led medication therapy management (MTM) on knowledge and adherence outcomes in patients on oral anticoagulants. SUBJECTS AND METHODS: An observational-cohort study was conducted in the surgery, cardiology and cardiothoracic surgery departments. A clinical pharmacist trained in MTM services conducted the MTM sessions according to the guidelines. The follow-up of the patients was conducted at scheduled visits to the hospital at 0, 4 and 8 months. The knowledge and adherence outcomes were assessed through a repeated measures analysis of variance, with P < 0.05 was statistically significant. RESULTS: Out of 100 patients, 94 patients were followed up on, and their data were analysed. The commonly prescribed oral anticoagulants were acenocoumarol (34%) and warfarin (29%). The baseline knowledge and adherence scores on oral anticoagulant medications were 43.40 ± 19.37 and 51.59 ± 25.34. The MTM services were provided after 4-month and 8-month intervals, knowledge scores were 71.38 ± 14.99 and 82.97 ± 9.92, and the adherence scores were 80.45 ± 11.95 and 88.56 ± 9.64, respectively. Thirty-four adverse drug reactions were reported, with an International Normalized Ratio range >6 for which anticoagulation reversal agents were used. CONCLUSION: The clinical pharmacist-led MTM services significantly improved knowledge ( P < 0.001) and adherence ( P < 0.001) of patients treated with oral anticoagulants at different time intervals. The pharmacist's role in anticoagulation management service will be helpful for physicians to optimise and maintain the dose.