Development of a Network for Care of Patients on Warfarin among Health Promoting Hospitals

Abstract

The objective of this action research was to evaluate the outcomes of network development for care of patients on warfarin among health promoting hospitals (HPHs) in Patumratwongsa district of Amnat Charoen province. All 7 HPHs in the district participated in the study which was conducted during October 2011-September 2012. The patients were either prescribed warfarin by a doctor in Patumratwongsa district hospital or referred to follow-up medication in the hospital by the regional or provincial hospital. The activities in the model included the establishment of warfarin clinic in the HPHs which were sub-units of the network, capacity building of PHPs, and monitoring the outcomes using 4 indicators: (1) the international normalized ratio or INR of each patient, (2) incidents of major bleedings, (3) patients’ following-up of the appointments to obtain drugs, and (4) patient satisfaction. It was found that 86.27 percent of patients received drugs according to the schedules, and 67.82 percent had the INR levels under control. Only 2.24 percent of the cases had demonstrated side effects of the treatment which included bleeding of gums and minimal bloody cough. No major bleeding was observed. It should be concluded that the establishment of warfarin network had resulted in close and more frequent observations of patients on warfarin by health volunteers. The patients had gain better knowledge and awareness on the possible side effects of the drug. Other achievements included early management of cases by a multidisciplinary team, gaining community participation, and increased capacity of health volunteers on the management of cases with warfarin. This approach should be applied to other health issues that require close supervision of care takers and the communities.