实现最佳华法林抗凝控制的挑战:一个全面的探索和提出的整体方法

IF 0.7 Q4 PHARMACOLOGY & PHARMACY INDONESIAN JOURNAL OF PHARMACY Pub Date : 2023-09-20 DOI:10.22146/ijp.8169
Wenny Putri Nilamsari, Indri Yuliani Hamdani, Budi Suprapti, Mochammad Yusuf Assegaf, Mohammad Yogiarto, None Suharjono
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引用次数: 0

摘要

在印度尼西亚,华法林仍然是最广泛使用的口服抗凝处方。然而,在印度尼西亚和世界上一些国家,达到治疗范围的时间仍然很短。本研究旨在从医疗保健专业人员、患者、卫生系统的角度分析华法林最佳控制的挑战,并提出解决这些挑战的策略。本研究分为两个阶段。第一阶段是前瞻性观察研究,旨在分析挑战,研究的第二阶段是焦点小组讨论,提出克服挑战的策略。本研究结果显示,TTR平均值为49.4±32.1,其中仅有37.5%的患者TTR≥65%。平均给药浓度为62.33±32.42%。在INR监测间期方面,几乎所有治疗前INR患者的INR监测间期均为剂量调整后1个月。同时,只有43.8%的患者属于依从性,仅有39.5%的患者对华法林有良好的认识,表明患者的依从性和知识水平并不理想。在本研究中,14.6%的患者接受了其他可能与华法林相互作用导致INR波动的药物。总之,本研究结果表明,华法林的最佳控制存在多重挑战,包括剂量一致性障碍、INR监测、患者的依从性和知识以及药物相互作用。然而,仍有改进的余地。拟议的战略可能会实现最佳效益,这是一种综合多方面战略来解决每个障碍的整体方法。
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Challenges in Achieving Optimal Warfarin Anticoagulation Control: A Comprehensive Exploration and Proposed Holistic Approaches
In Indonesia warfarin remains the most widely oral anticoagulation prescribed. However, the time in therapeutic range remain low in Indonesia and also in some countries in throughout the world. This study aimed to analyse the challenges of optimal warfarin control from the perspectives of healthcare professionals, patients, health system, and to propose strategies to address these challenges. This research consists of two stages. The first stage was a prospective observational study aiming to analyse the challenges and the second stage of the research was focus group discussion to propose strategies to overcome the challenges. The result of this study showed that the average of TTR was 49.4 ± 32.1, where only 37.5% patients had TTR ≥ 65%. The average dosing consistency obtained was 62.33 ± 32.42%. With regard to INR monitoring interval, almost all patient who had supraterapeutic INR had their INR monitoring interval set to 1 month after the dose adjustment. There were also identified that only 43.8% patients classified as adherent and only 39.5 % patients had good knowledge of warfarin, indicating that the level of medication adherence and knowledge was not optimal. In this study, 14.6% of patients received other drugs that potentially interacted with warfarin that cause fluctuate INR. In conclusion, this study's results showed that there were multiple challenges for optimal warfarin control including barrier for dosing consistency, INR monitoring, patients’ adherence and knowledge, as well as drug interactions. However, there will be still room for improvement. The proposed strategy that likely will achieve optimal benefit was a holistic approach that combine multifaceted strategies to address each barrier.
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来源期刊
INDONESIAN JOURNAL OF PHARMACY
INDONESIAN JOURNAL OF PHARMACY PHARMACOLOGY & PHARMACY-
CiteScore
1.20
自引率
0.00%
发文量
38
审稿时长
12 weeks
期刊介绍: The journal had been established in 1972, and online publication was begun in 2008. Since 2012, the journal has been published in English by Faculty of Pharmacy Universitas Gadjah Mada (UGM) Yogyakarta Indonesia in collaboration with IAI (Ikatan Apoteker Indonesia or Indonesian Pharmacist Association) and only receives manuscripts in English. Indonesian Journal of Pharmacy is Accredited by Directorate General of Higher Education. The journal includes various fields of pharmaceuticals sciences such as: -Pharmacology and Toxicology -Pharmacokinetics -Community and Clinical Pharmacy -Pharmaceutical Chemistry -Pharmaceutical Biology -Pharmaceutics -Pharmaceutical Technology -Biopharmaceutics -Pharmaceutical Microbiology and Biotechnology -Alternative medicines.
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