Educating patients about warfarin therapy using information technology: A survey on healthcare professionals’ perspectives

Main Article Content

Sayeed Nasser
Judy Mullan
Beata Bajorek



Objective: To explore healthcare professionals’ views about the benefits and challenges of using information technology (IT) resources for educating patients about their warfarin therapy.

Methods: A cross-sectional survey of both community and hospital-based healthcare professionals (e.g., doctors, pharmacists and nurses) involved using a purpose-designed questionnaire. The questionnaires were distributed using a multi-modal approach to maximise response rates.

Results: Of the total 300 questionnaires distributed, 109 completed surveys were received (43.3% response rate). Over half (53.2%) of the healthcare participants were aged between 40-59 years, the majority (59.5%) of whom were female. Fifty nine (54.1%) participants reported having had no access to warfarin-specific IT-based patient education resources, and a further 19 (38.0%) of the participants who had IT-access reported that they never used such resources. According to the healthcare participants, the main challenges associated with educating their patients about warfarin therapy included: patient-related factors, such as older age, language barriers, cognitive impairments and/or ethnic backgrounds or healthcare professional factors, such as time constraints. The healthcare professionals reported that there were several aspects about warfarin therapy which they found difficult to educate their patients about which is why they identified computers and interactive touch screen kiosks as preferred IT devices to deliver warfarin education resources in general practices, hospital-based clinics and community pharmacies. At the same time, the healthcare professionals also identified a number of facilitators (e.g., to reinforce warfarin education, to offer reliable and easily comprehensible information) and barriers (e.g., time and costs of using IT resources, difficulty in operating the resources) that could impact on the effective implementation of these devices in educating patients about their warfarin therapy.

Conclusion: The findings of the study suggest that there is a need for improving healthcare professionals’ use of, and access to IT-based warfarin education resources for patients. The study findings also suggest addressing the concerns raised by the healthcare professionals when implementing such IT resources successfully to help educate patients about their warfarin therapy.

Abstract 2256 | PDF Downloads 714


1. Bajorek BV. A review of the safety of anticoagulants in older people using the medicines management pathway: weighing the benefits against the risks. Ther Adv Drug Saf. 2011;2(2):45-58.

2. Stoop AP, van’t Riet A, Berg M. Using information technology for patient education: realizing surplus value? Patient Educ Couns. 2004;54(2):187-195.

3. Wofford JL, Smith ED, Miller DP. The multimedia computer for office-based patient education: a systematic review. Patient Educ Couns. 2005;59(2):148-157.

4. Hegney D, Eley R, Buikstra E, Fallon T, Soar J, Gilmore. Australian Nurses Access and Attitudes to Information Technology- A National Survey H-A Park et al (Eds);IOS Press in: Consumer-Centered Computer-Supported Care for Healthy People; 2006. p688-692.

5. Lewis D. Computer-based Approaches to Patient Education: A Review of the Literature. J Am Med Inform Assoc. 1999;6(4):272-282.

6. Luo N, Koh WP, Ng WY, Yau JW, Lim LK, Sim SS, Tay EG. Acceptance of Information and Communication Technologies for Healthcare Delivery: A SingHealth Polyclinics Study. Ann Acad Med Singapore. 2009;38(6):529-528.

7. Jackson CL, Bolen S, Brancati FL, Batts-Turner ML, Gary TL. A Systematic Review of Interactive Computer-assisted Technology in Diabetes Care Interactive Information Technology in Diabetes Care. J Gen Intern Med. 2006;21(2):105-110.

8. Strömberg A, Ahlén H, Fridlund B, Dahlström U. Interactive education on CD-ROM- a new tool in the education of heart failure patients. Patient Educ Couns. 2002;46(1):75-81.

9. Flynn D, van Schaik P, van Wersch A, Ahmed T, Chadwick D. The utility of a multimedia education program for prostate cancer patients: a formative evaluation. Br J Cancer. 2004;91(5):855-860.

10. Celler BG, Lovell NH, Basilakis J. Using information technology to improve the management of chronic disease. Med J Aust. 2003;179(5):242-246.

11. Nasser S, Mullan J, Bajorek B. Challenges of older patients’ knowledge about warfarin therapy. J Prim Care Community Health. 2012;3:65-74.

12. Denizard-Thompson N, Singh S, Wells M, Wofford JL. Using iPod technology for warfarin education: Mobile computer-assisted patient education for improving office efficiency [abstract]. J Gen Intern Med. 2008;23(Suppl 2):230.

13. Beyth RJ, Quinn L, Landefeld CS. A multicomponent intervention to prevent major bleeding complications in older patients receiving warfarin. Ann Intern Med. 2000;133(9):687-695.

14. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329(7456):15-19.

15. Khan TI, Kamali F, Kesteven P, Avery P, Wynne H. The value of education and self-monitoring in the management of warfarin therapy in older patients with unstable control of anticoagulation. Br J Haematol. 2004;126(4):557-564.

16. Pernod G, Labarère P, Yver J, Satger B, Allenet B, Berremili T, et al. EDUC’AVK: reduction of oral anticoagulant-related adverse events after patient education: a prospective multicenter open randomized study. J Gen Intern Med. 2008;23(9):1141-1146.

17. Tang EO, Lai CS, Lee KK, Wong RS, Cheng G, Chan TY. Relationship between patients’ warfarin knowledge and anticoagulation control. Ann Pharmacother. 2003;37(1):34-39.

18. Kagansky N, Knobler H, Rimon E, Ozer Z, Levy S. Safety of Anticoagulation Therapy in Well-informed Older Patients. Arch Intern Med. 2004;164(18):2044-2050.

19. Cheah GM, Martens KH. Coumadin Knowledge Deficits: Do Recently Hospitalized Patients Know How to Safely Manage the Medication? Home Healthc Nurse. 2003;21(2):94-100.

20. Lee FW. Adoption of electronic medical records as a technology innovation for ambulatory care at the medical university of South Carolina. Top Health Inf Manage. 2000;21(1):1-20.

21. Schmitt M, Titler M, Herr K, Ardery G. Challenges of web-based education in educating nurses about evidence-based acute pain management practices for older adults. J Contin Educ Nurs. 2004;35(3):121-127.

22. Ullrich PF, Vaccaro AR. Patient Education on the Internet: Opportunities and Pitfalls. Spine (Phila). 2002;27(7):E185-188.

23. Henning J. Recommended Sample Size for Accurate Surveys. (accessed 22 August 2011).

24. Paul CL, Walsh RA, Tzelepis F. A monetary incentive increases postal survey response rates for pharmacists. J Epidemiol Community Health. 2005;59(12):1099-1101.

25. Crouch S, Robinson P, Pitts M. A comparison of general practitioner response rates to electronic and postal surveys in the setting of the National STI Prevention Program. Aust N Z J Public Health. 2011;35(2):187-189.

26. Miller RH, Hillman JM, Given RS. Physician Use of IT: Results from the Deloitte Research Survey. J Healthc Inf Manag. 2004;18(1):72-80.

27. Brooks RG, Menachemi N. Physicians’ Use of Email With Patients: Factors Influencing Electronic Communication and Adherence to Best Practices. J Med Internet Res. 2006;8(1):e2.

28. Keulers BJ, Spauwen PH. Can face-to-face patient education be replaced by computer-based patient education? Eur J Plast Surg. 2003;26:280-284.

29. Huang JP, Chen HH, Yeh ML. A Comparison of Diabetes Learning With and Without Interactive Multimedia to Improve Knowledge, Control, and Self-Care Among People With Diabetes in Taiwan. Public Health Nurs. 2009;26(4):317-328.

30. Neafsey PJ, Strickler Z, Shellman J, Chartier V. An interactive technology approach to educate older adults about drug interactions arising from over-the-counter self-medication practices. Public Health Nurs. 2002;19(4):255-262.

31. Lo SF, Wang YT, Wu LY, Hsu MY, Chang SC, Hayter M. A cost–effectiveness analysis of a multimedia learning education program for stoma patients. J Clin Nurs. 2010;19(13-14):1844-1854.

32. Proudfoot JG. Computer-based treatment for anxiety and depression: is it feasible? Is it effective? Neurosci Biobehav Rev. 2004;28(3):353-363.

33. Bajorek BV, Ogle SJ, Duguid MJ, Shenfield GM, Krass I. Balancing risk versus benefit: the elderly patient’s perspective on warfarin therapy. Pharm Pract (Internet). 2009;7(2):113-123.

34. Khan TI, Kamali F, Kesteven P, Avery P, Wynne H. The value of education and self-monitoring in the management of warfarin therapy in older patients with unstable control of anticoagulation. Br J Haematol. 2004;126(4):557-564.

35. Sobel RM, Paasche-Orlow MK, Waite KR, Rittner SR, Wilson EA, Wolf MS. Asthma 1-2-3: A Low Literacy Multimedia Tool to Educate African American Adults About Asthma. J Community Health. 2009;34(4):321-327.

36. Hawley ST, Zikmund-Fisher B, Ubel P, Jancovic A, Lucas T, Fagerlin A. The impact of the format of graphical presentation on health-related knowledge and treatment choices. Patient Educ Couns. 2008;73(3):448-455.

37. Mansoor LE, Dowse R. Effect of Pictograms on Readability of Patient Information Materials. Ann Pharmacother. 2003;37(7-8):1003-1009.

38. Andreassen HK, Bujnowska-Fedak MM, Chronaki CE, Dumitru RC, Pudule I, Santana S, Voss H, Wynn R. European citizens' use of E-health services: A study of seven countries. BMC Public Health. 2007;7:53.

Most read articles by the same author(s)