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Improving doctor-patient communication yields significant health benefits
Date:10/11/2007

arfarin is a notoriously challenging medication for doctors and patients to manage, and complications from warfarin are the most common cause of adverse medication events in community settings, according to the lead investigators.

In previous studies, Schillinger and Machtinger found that nearly one half of patients on anticoagulants were not taking their medication accurately, but did not realize it. When describing the dose and frequency of the medication, patients and doctor often had two completely different understandings. These misunderstandings were more frequent among patients with limited literary skills, those for whom English was not their first language, and those with memory problems. Patients who had misunderstood their prescriptions were more likely to be under-anticoagulated and at risk for stroke, as well as over-anticoagulated and at risk for life-threatening bleeding.

Based on these findings, the researchers developed a three-step communication approach for their current study and selected patients whose lab tests showed that their blood was not in the target range of anticoagulation. The three-step approach involves

  1. having the patient describe how much medication he/she is taking and how often (to identify misunderstanding),
  2. giving the patient a VMS along with written instructions both in English and the patient's native language, and
  3. asking the patient to "teach back" what he/she has just learned so as to ensure common understanding.

The study involved 147 patients, with half of the participants being randomized to receive the VMS along with brief, scripted medication counseling each time they came to clinic over 90 days, in addition to their standard care in an anticoagulation clinic. The other half received standard care, which includes medication counseling using non-standardized verbal and written instructions.

Study findings showed that the blood anticoagulation status of pat
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Contact: Vanessa deGier
vdegier@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
Source:Eurekalert

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