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Patient Attitudinal and Behavioral Factors Associated with Warfarin Non-adherence at Outpatient Anticoagulation Clinics

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Abstract

Background

Warfarin is an anticoagulant effective in preventing stroke, but it has a narrow therapeutic range requiring optimal adherence to achieve the most favorable effects.

Purpose

The goal of this study was to examine specific patient factors that might help explain warfarin non-adherence at outpatient anticoagulation clinics.

Method

In a prospective cohort study of 156 adults, we utilized logistic regression analyses to examine the relationship between the five Treatment Prognostics scales from the Millon Behavioral Medicine Diagnostic (MBMD), as well as three additional MBMD scales (Depression, Future Pessimism, and Social Isolation), and daily warfarin non-adherence assessed using electronic medication event monitoring systems caps over a median of 139 days.

Results

Four of the five Treatment Prognostic scales and greater social isolation were associated with warfarin non-adherence. When controlling for pertinent demographic and medical variables, the Information Discomfort scale remained significantly associated with warfarin non-adherence over time.

Conclusion

Although several factors were related to warfarin non-adherence, patients reporting a lack of receptivity to details regarding their medical illness seemed most at risk for warfarin non-adherence. This information might aid in the development of interventions to enhance warfarin adherence and perhaps reduce adverse medical events.

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Acknowledgments

This study was supported by grants from the National Institutes of Health (NIH, R01-HL66176) and the Agency for Healthcare Research and Quality (AHRQ, P01-HS11530). Dr. Kimmel was also supported by NIH Grant K24HL070936.

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Authors and Affiliations

  1. Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA

    Dean G. Cruess

  2. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Alec B. Platt, Jason D. Christie, Robert Gross, Joshua P. Metlay, Brian L. Strom & Stephen E. Kimmel

  3. Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    A. Russell Localio, Alec B. Platt, Colleen M. Brensinger, Jason D. Christie, Robert Gross, Catherine S. Parker, Maureen Price, Joshua P. Metlay, Abigail Cohen, Craig W. Newcomb, Brian L. Strom & Stephen E. Kimmel

  4. Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA

    Joshua P. Metlay

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  1. Dean G. Cruess
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  2. A. Russell Localio
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  3. Alec B. Platt
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  4. Colleen M. Brensinger
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  5. Jason D. Christie
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  6. Robert Gross
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  7. Catherine S. Parker
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  8. Maureen Price
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  9. Joshua P. Metlay
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  10. Abigail Cohen
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  11. Craig W. Newcomb
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  12. Brian L. Strom
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  13. Stephen E. Kimmel
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Correspondence to Dean G. Cruess.

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Cruess, D.G., Localio, A.R., Platt, A.B. et al. Patient Attitudinal and Behavioral Factors Associated with Warfarin Non-adherence at Outpatient Anticoagulation Clinics. Int.J. Behav. Med. 17, 33–42 (2010). https://doi.org/10.1007/s12529-009-9052-6

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  • DOI: https://doi.org/10.1007/s12529-009-9052-6

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