Prepared for:

1
The Use of Oral Anticoagulant MedicationsPRESENT
ATION Key Findings from Surveys of Patients,
Caregivers, and Physicians

• Prepared for
• The National Consumers League
• September 21, 2005
• J23715

2
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.

3
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 physicians 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.

4
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 care-giving tasks around
  anticoagulant use.
• Interviews conducted between May 19 - 26, 2005.

5
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.

6
Summary of Key Findings
7
Summary of Key Findings Patients

• People on oral anticoagulants face complex health
  problems and have considerable health management
  needs.
• Almost all patients on oral anticoagulants also
  take other prescription drugs and many take
  over-the-counter (OTC) drugs and
  vitamins/supplements.
• 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.
• There are gaps in the management of the health
  care of patients on oral anticoagulants.
• There is room for improvement in the relationship
  between oral anticoagulant users and their
  physicians.

Continued gt
8
Summary of Key Findings Patients, continued

• 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.
• Patients have some difficulties and concerns
  about being on an oral anticoagulant.
• Adverse reactions to oral anticoagulants are
  common. Many do not change their behavior or
  seek help.
• 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.
• 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.

9
Summary of Key Findings Caregivers

• Caregivers are assisting oral anticoagulant users
  who have considerable health management needs.
• Caregivers are highly involved in helping their
  family members manage their oral anticoagulant
  regimen.
• Caregivers are generally aware of the complexity
  of oral anticoagulant medication, knowledge of
  precautions could be improved.
• Caregivers could use more assistance in helping
  their family members with management of their
  anticoagulant regimen.
• 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.

10
Summary of Key Findings Caregivers, continued

• 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 donts of managing and
  anticoagulant regimen.

11
Summary of Key Findings Physicians

• 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.

12
Executive Summary
13
Three Key Themes Across Groups

• Oral anticoagulant use presents a challenge to
  patients, caregivers, and physicians.
• There are gaps in education around oral
  anticoagulant use, both for patients and
  caregivers.
• There are gaps in the health care management of
  oral anticoagulant patients.

14
Key Theme 1 Oral anticoagulant use presents a
challenge to patients, caregivers and physicians.
15
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

16
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
Q310 In general, how would you describe your own
health? Base Qualified respondents (n426)
17
More than half of oral anticoagulant users suffer
four or more of these conditions.
Q335 Have you been told by a doctor that you have
. . .? Base Qualified respondents (n 426)
Less than 1 percent
18
Most oral anticoagulant patients are taking
multiple prescription medications and OTCs.
Q500 Including your blood thinning medication,
how many different prescription medications do
you take on a regular or ongoing basis? Q507 In
addition to anticoagulant, are you also taking
Plavix on a regular basis? Q510 Are you taking
any over-the-counter medications such as aspirin,
Motrin, Tylenol, Tagamet, or Zantac, on a regular
or ongoing basis? Q512 Are you taking any
vitamins or supplements, such as ginkgo, ginseng
or St. Johns Wort, on a regular or ongoing
basis? Q508 Are you taking aspirin as a blood
thinning medication? Base Qualified
respondents (n426)
19
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
Caregiver responses in contrast 65 of their
family members see for 4 or more doctors
Q410 In addition to your regular doctor, how many
other doctors, including specialists, have you
seen in the past year? Base Qualified
respondents (n 426)
20
Most caregivers are caring for someone with
memory impairment.
68
Q820 Does your family member suffer from memory
impairment? If so, how severe is this
impairment? Base Qualified respondents (n109)
21
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.

22
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
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 (n426)
23
Nearly 1 in 4 caregivers are less than very
confident that their family members are taking
the oral anticoagulant medication correctly.
22
Q530 Overall, how confident are you that you
family member is taking his/her oral
anticoagulant medication the correct way? Base
Qualified respondents (n109)
24
Patients recognize the importance of safe
behaviors Compliance is more difficult.
Importance of and compliance with anticoagulant
precautions
Q640 As far as you know, how important is it for
people who take anticoagulants to . . . ?
Q610 How often do you do the following? Base
Qualified respondents (n426)
25
Following an appropriate diet is difficult for
many patients.
Q910 How easy or difficult is it for you to . . .
? Base All respondents (n426)
26
2 in 5 of caregivers feel that family members
need at least some encouragement to follow
instructions associated with taking the
anticoagulant medication safely
40
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 (n109)
27
Most caregivers report that their family members
need at least some assistance following
recommendations.
70
69
67
64
63
60
59
58
54
51
Q510 How much assistance does your family member
need to follow these recommendations related to
taking his/her anticoagulant? Base Qualified
respondents (n109)
28
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
Q610 Thinking about your experiences managing
patients who take oral anticoagulants, which
would you say are the biggest challenges you
face? Base Qualified Respondents (n101)
29
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
48
Q555 Overall, how well do you think this
patient is managing his/her oral anticoagulant?
Base Qualified Respondents (n101)
30
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
26
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 (n101)
31
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.

32
Most patients have experienced adverse reactions
to oral anticoagulant use.
Ever experienced any of these adverse reactions
as a result of taking their anticoagulant
Note Percentages shown are the sum of responses
always, most of the time, sometimes, and
rarely.
Q615 How often, if at all, do you experience any
of the following as a result of taking the
anticoagulant? Base All respondents (n426)
33
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
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
8
Q630 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. Base Qualified respondents
(n426) NOTE RECALCULATED TO BASE OF ALL
QUALIFIED RESPONDENTS
34
Half of patients who experience adverse reactions
do nothing to change their behavior.
Change in behavior after experiencing side
effects from anticoagulant use
Lifestyle changes test regularly,
changed/added medications, monitored health
status, etc.
Q635 After you have experienced side effects or
other adverse reactions due to taking
anticoagulant, what, if anything, are you doing
differently now? Base Qualified respondents
who experienced at least 1 side effect (n395)
35
Many patients who experience adverse reactions do
not contact their doctor about the problem.
Response to experiencing side effects from
anticoagulant use
Q620 What did you do when you experienced side
effects from taking anticoagulant? Please select
all that apply.Base Qualified respondents who
experienced at least 1 side effect (n395)
36
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.
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 (n101)
37
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

38
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
34
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 (n94)
39
Caregivers are involved in all aspects of
anticoagulant management.
Q340 Do you assist your family member in any of
the following ways? Base Qualified respondents
(n109)
40
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
Patient responses in contrast Patient
himself/herself 82Doctor 11Spouse or
Caretaker 3Pharmacist 2Nurse 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 (n109)
41
Many caregivers find it at least somewhat
difficult to assist with their family members
oral anticoagulant regimen.
Percent of caregivers finding it very difficult
or somewhat difficult to
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 (n109)
42
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

43
Anticoagulant patients require more of
physicians time than other chronically ill
patients.
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? Base Qualified
Respondents (n101)
44
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
Average number of visits a year 7
Not sure 2
Q531 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
(n101)
45
Key Theme 2 There are gaps in education around
oral anticoagulant use, both for patients and
caregivers.
46
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.

47
Patients recognize the importance of safe
behaviors, with some weaker areas.
Importance of anticoagulant precautions
Q640 As far as you know, how important is it for
people who take anticoagulants to . . . ? Base
Qualified respondents (n426)
48
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
Q500 Regarding your family members use of
their oral anticoagulant, do you understand the
following? Base Qualified respondents (n109).
49
A small but troubling minority of caregivers have
had problems with a lack of information or
conflicting information.
Q710 How much of a problem has each of the
following been for your or your family
member? Base Qualified respondents (n109)
50
There are gaps in education of new oral
anticoagulant patients.
Q520 Thinking about the first time when the
doctor prescribed the anticoagulant for you, did
he or she. . .? Base Qualified respondents
(n426)
51
Many physicians do not tell their patients
important information when they first start
patients on and anticoagulant medication.
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 (n101) 1 not sure
52
Key Theme 3There are gaps in the health care
management of oral anticoagulant patients.
53
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.

54
Good communication and information are seen by
physicians as most effective in increasing
patients compliance with oral anticoagulant
medication.
Q620 How effective do you think the following
approaches to increasing patient oral
anticoagulant compliance would be? Base
Qualified Respondents (n101)
55
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.
Q416 How often, if ever, do you or your office
staff contact your oral anticoagulant patients
to.? Base Qualified respondents (n101)
56
Patients and physicians do a good job managing
multiple prescriptions Could improve management
of OTCs.

• Q505 In the past year, have any of the following
  people reviewed with you all of the prescription
  drugs you are taking?
• Base Respondents taking more than one
  prescription medication (n424)
• Q440 Do all of the doctors you see know that you
  are taking the anticoagulant?
• Base Respondents seeing more than one doctor
  (n398)
• Q515 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 (n323)
• Less than 1 percent
• Includes decline to answer (2)

57
While physicians are doing well with reviewing
medication, many patients are not being asked
about compliance, problems, and diet. (Case Study)
Q529 On this patients most recent visit did
you? Base Qualified respondents (n101)
58
There are considerable gaps in knowledge and
communication about the blood test goals.
includes respondents saying it fluctuates
Q830 Has a health care professional ever told you
what your number should be? Q840 Does your
number usually stay within the desired
range? Base Qualified respondents (n426)
59
Many patients do not know their latest PT/INR
number.
PT/INR number last time they had their blood
tested
4 Decline to answer
Q835 What was your number when you were last
tested? Base Respondents who were told of INR
(n426)
60
Many patients are not always getting clear and
timely feedback about blood test results.
Q815 After having a blood test, how often, if
ever, does someone contact you to give you your
blood test results? Base Qualified respondents
who get blood checked (n419) Q825 Last time you
had your blood tested, did someone explain the
results in a way that you could
understand? Base Qualified respondents who get
blood checked (n419) Q818 If nobody from your
doctors office contacts you to give you your
blood test results, do you usually contact the
doctors office yourself? Base Qualified
respondents who do not get contacted every time
(n73) NOTE SMALL BASE
61
One in four physicians do not always call or
mail the patients to inform them about their INR
test results.
Q425 Which of the following best describes your
offices general approach to contacting patients
regarding their INR results? Base Qualified
Respondents (n101). Note Multiple responses
question, respondents could say that they phone
and send letters.
62
When informing their patients about their INR
test results, many physicians do not tell their
patients their actual numeric INR value.
Q435 What terminology do you generally use to
describe INR test results to your oral
anticoagulation patients? Base Qualified
Respondents (n101)
63
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.

64
Many caregivers find it difficult to speak with
somebody in the doctors office when they have
questions about the use of the anticoagulant
Pharmacists are more accessible.
How easy or difficult is it for you to
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 doctors 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 (n109)
65
Caregivers see areas for improvement in
communication with their family members
physician.
Q610 How would you rate your family members
physician on each o the following criteria? Base
Qualified respondents (n109)
66
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.

67
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
Note Multiple responses allowed
Q435 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? Base Qualified respondents (n426)
68
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.
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
(n101)
69
Most caregivers feel they would benefit from
having someone in the doctors office they could
call for information. Other solutions could also
be of help.
72
67
65
61
61
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 (n109)
70
Written communication is seen by many physicians
as a good method of relaying information.
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 (n101)
71
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 instructions64 received written
instructions12 were not sure
Not sure 5
Q528 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. Base
Qualified respondents (n426)
72
1 in 3 physicians does not provide any of their
oral anticoagulant patients with written
instructions.
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 (n101)
73
Patients with access to another health care
professional have better management of blood
testing.
Q815 After having a blood test, how often, if
ever, does someone contact you to give you your
blood test results? Q825 Last time you had your
blood tested, did someone explain the results in
a way that you could understand? Base
Qualified respondents who get blood checked
(n419) Q830 Has a health care professional ever
told you what your number should be? Base
Qualified respondents (n426) Q835 What was your
number when you were lasted tested? Base
Respondents who were told of INR (n338)
74
Health Care Management Score
75
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
Q640 As far as you know, how important is it for
people who take anticoagulants to . . . ? Base
Qualified respondents (n426)
76
Patients with better health care management are
more compliant with oral anticoagulant
precautions.
who indicate they always do the following
Q610 How often do you do the following? Base
Qualified respondents (n426)
77
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
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 (n426)
78
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
Q910 How easy or difficult is it for you
to Base Qualified respondents (n426)
79
Preliminary Conclusions
80
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
  patients care need to be accessible to
  caregivers.