Improving Warfarin Patient Compliance

All patients taking warfarin (Coumadin) require regular blood checks for clotting time (International Normalized Ratio or INR), but many patients are not compliant due to various reasons including lack of medication education or barriers prohibiting the return for lab testing. The purpose of this quality improvement project was to determine specific demographics of patients taking warfarin, assess for barriers to INR check compliance and increase warfarin awareness and education level of these patients. The methods of this study included completing a needs assessment using a demographic and education survey. The study collected baseline data to determine barriers and possible knowledge gaps in the patient population of a small family practice clinic in Utah County, Utah who are currently taking warfarin. Research staff created and distributed an educational pamphlet to address gaps in knowledge and improve health literacy. The results of the needs assessment of this study revealed that major barriers to regular INR checks include walk-in appointments taking too long, feeling that INR checks are unnecessary as the clotting levels have been stable for long periods of time, and not having access to an easy method for lab testing. Major educational gaps revolved around the mechanism of action of warfarin, as well as signs and symptoms of major adverse reactions to the medication. In conclusion, ways to overcome barriers identified for this patient demographic include incorporating an INR check reminder system in the upcoming EMR change and improving patient education. Additional suggestions for increasing patient compliance are to streamline INR checks to decrease patient wait times by either obtaining a higher number of machines, selecting two days of the month for INR checks at the clinic, or promoting distribution of home monitoring devices.