Abstract
Background: Available literature supports the role of a pharmacist in the management of patients on warfarin therapy. However, randomized controlled trials on the influence of pharmacists’ interventions on the quality of life (QoL) in elderly patients on warfarin are missing. The aim of this study was to investigate the effect of pharmacists’ interventions on QoL of older adult patients receiving warfarin therapy in rural areas. The study aimed also to explore factors influencing QoL in these patients. Methods: We conducted a prospective randomized trial in a community pharmacy setting in a rural area. Eligible patients were randomized into intervention and control groups. Repeated education and a follow up plan were provided to the participants in the intervention group, and, if needed, pharmacist intervened to optimize warfarin therapy in collaboration with GP. QoL was measured using the DASS (Duke Anticoagulation Satisfaction Scale) questionnaire in both groups after 6 months. Results: In total, 131 participants finished the study (median age 73 years; 51.1% men). Participants in the intervention group scored significantly lower in all 3 domains of the DASS questionnaire at 6 months, namely limitations, hassles and burden, and psychological impact, as well as in overall scores (median score 86.5 and 66.0 in control and intervention group, respectively; p<0.001), indicating higher QoL in the intervention group. Adverse drug reactions (ADRs) and pharmacist’s intervention were predictive of QoL (r 2 =65.5%, P<0.001). Experience of ADRs was the strongest negative predictor of QoL (P<0.001). Conclusions: The study demonstrated that pharmacist’s intervention had positive impact on the QoL among older adult patients in rural areas. ADRs and pharmacist’s intervention were identified as predictive factors for QoL, whereby experience of ADRs was the strongest negative predictor. These results suggest that older adult patients receiving warfarin in rural areas could benefit from a community pharmacist intervention.
Pharmacist-led interventions might improve quality of life among older adult patients receiving warfarin treatment in rural areas: results from a randomized controlled trial
