ผลการให้บริบาลทางเภสัชกรรมสำหรับผู้ป่วยที่ได้รับยาวอร์ฟารินครั้งแรกในหอผู้ป่วยอายุรกรรมและศัลยกรรม

Abstract

The objective of this study was to determine the effect of pharmaceutical care for patient who received warfarin in the first time to a percent of international normalized ration (INR) in therapeutic range during July 2014 - October 2015 in the medical and surgical wards at Phramongkutklao hospital. This study design was a quasi-experiment to compare between the control group (traditional practice, n=40) and the experimental group (pharmacist intervention; n=40). Baseline characteristics between the two groups were not statistically difference (p>0.05). The most indication of warfarin in the both groups are atrial fibrillation. The percentage of INR in therapeutic range in the experimental group was higher than control group at discharge (52.5% vs 27.5%, p=0.022) while the result during stay in hospital (15.0% vs 15.0%; p=0.100) and follow-up at the first time at outpatient clinics (30.0% vs 15.0%; p=0.108) were not difference. Drug related problems (DRPs) focusing on warfarin usage revealed that only one haemorrhagic complication event was found in the control group after discharge but not found in the experimental group which was not difference (p=0.500). No thromboembolic complication was found in any group, but drug interaction in the experimental group was significantly less than the control group at discharge (80.0% vs 92.5%; p=0.000) and at the first time follow-up in the outpatient clinic (72.5% vs 82.5%; p=0.013). The drugs mostly interaction with warfarin were omeprazole, aspirin and simvastatin. The mean score of the knowledge evaluation in the experimental group was higher than the control group in both of comparison between groups at the first time follow-up in outpatient clinics (2.95 vs 8.38; p=0.000) and within the experimental group; during stay in hospital (pre-test) and follow-up at the first time at outpatient clinics (post-test) (from 1.25 to 8.38; p=0.000). These results indicated that pharmaceutical care could effectively improve warfarin therapy to target, decrease DRPs and enhance warfarin knowledge for patients.