Construction and Validation of a Protocol Targeting Patients on Oral Anticoagulation with Warfarin

Barbosa, Hannah Cardoso; Torres, Heloisa de Carvalho; Oliveira, João Antônio de Queiroz; Santos, Rebeca Priscila de Melo; Costa, Josiane Moreira da; Miranda, Leonardo Gonçalves; Pagano, Adriana Silvina; Praxedes, Marcus Fernando da Silva; Martins, Maria Auxiliadora Parreiras

Hannah Cardoso Barbosa

Conception and design of the research

Acquisition of data

Analysis and interpretation of the data

Statistical analysis

Obtaining financing

Writing of the manuscript

Critical revision of the manuscript for important intellectual content

Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brazil

https://orcid.org/0000-0001-8635-3509

Heloisa de Carvalho Torres

Conception and design of the research

Acquisition of data

Analysis and interpretation of the data

Critical revision of the manuscript for important intellectual content

Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brazil

João Antônio de Queiroz Oliveira

Acquisition of data

Analysis and interpretation of the data

Statistical analysis

Critical revision of the manuscript for important intellectual content

Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brazil

Rebeca Priscila de Melo Santos

Acquisition of data

Analysis and interpretation of the data

Critical revision of the manuscript for important intellectual content

Hospital Risoleta Tolentino Neves, Belo Horizonte, MG – Brazil

Josiane Moreira da Costa

Acquisition of data

Analysis and interpretation of the data

Critical revision of the manuscript for important intellectual content

Universidade Federal dos Vales do Jequitinhonha e Mucuri, Teófilo Otoni, MG – Brazil

Leonardo Gonçalves Miranda

Acquisition of data

Analysis and interpretation of the data

Critical revision of the manuscript for important intellectual content

Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brazil

Adriana Silvina Pagano

Analysis and interpretation of the data

Statistical analysis

Critical revision of the manuscript for important intellectual content

Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brazil

Marcus Fernando da Silva Praxedes

Conception and design of the research

Acquisition of data

Analysis and interpretation of the data

Writing of the manuscript

Critical revision of the manuscript for important intellectual content

Universidade Federal do Recôncavo da Bahia (UFRB), Cruz das Almas, BA – Brazil

https://orcid.org/0000-0003-4226-6926

Maria Auxiliadora Parreiras Martins

Acquisition of data

Analysis and interpretation of the data

Statistical analysis

Obtaining financing

Writing of the manuscript

Critical revision of the manuscript for important intellectual content

Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brazil

Mailing Address: Hannah Cardoso Barbosa • Av. Pres. Antônio Carlos, 6627. Postal Code 31270-901, Pampulha, Belo Horizonte, MG – Brazil E-mail: hannahcbarbosa@gmail.com

Potential conflict of interest

No potential conflict of interest relevant to this article was reported.

Original items	Level of Relevance (CVC)	Level of adequacy (CVC)	Degree of Clarity (CVC)
1 – What is your greatest difficulty in controlling the anticoagulant?	1.00	1.00	0.94
2 – Can you explain that difficulty?	1.00	1.00	0.94
3 – Tell me about some situation that you went through because of that difficulty.	0.97	0.97	1.00
4 – Do you take warfarin as advised?*	0.91	0.88	0.67**
5 – Have you ever interrupted your warfarin treatment? Why?*	0.91	0.94	0.88
6 – Do you think your eating habits may compromise the treatment with warfarin?*	0.97	0.97	1.00
7 – How often and how many vegetables and green leaves do you eat?*	0.94	0.88	0.97
8 – Do you smoke cigarettes or consume alcoholic beverages? How much and how often?*	0.91	0.82	0.94
9 – Do you believe that other medications may interfere in anticoagulation control?*	0.97	0.97	0.91
10 – What do you do when you notice bleeding?*	1.00	1.00	0.97
11 – How do you feel about having to take anticoagulants?	0.97	0.97	0.94
12 – Do you think that warfarin might cause you harm?*	0.85	0.91	0.97
13 – Did you have to stop doing things you enjoy after you began to take warfarin?	0.85	0.85	0.91
14 – What bothered you the most since you began the treatment with warfarin?	0.88	0.85	0.88
15 – How do you feel about having to do frequent blood collections?*	0.97	0.94	1.00
16 – Do you believe that meditation or praying may improve your treatment?*	0.76**	0.70**	0.82
17 – What are your objectives for having treatment with warfarin?*	0.94	0.91	0.90
18 – What do you think you can do in order to improve your treatment?	0.97	1.00	0.97
19 – What would you change in your life in order to feel better?	0.70**	0.64**	0.67**
20 – What problems might interfere with the treatment and achieving your goals?	0.91	0.94	0.91
21 – Is there anyone who could help with your treatment?	0.91	0.91	0.91
22 – Do you know what might happen if you do not care for yourself?	0.97	0.85	0.73**
23 – Shall we work together to plan to care for your health?	0.94	0.97	0.88
24 – Talk about what you can do, step by step, to improve your treatment.	0.76**	0.79	0.88
25 – What are you really going to do to get better?	0.88	0.88	0.88
26 – When are you going to start?	0.85	0.88	0.88
27 – What have you learned from this experience?	0.91	0.94	0.82
28 – What difficulties did you have in following the plan?	0.91	0.91	0.85
29 – What would you do differently?	0.82	0.85	0.82
30 – Now that you have finished the plan, what will you do?	0.79	0.79	0.82
CVC average	0.92	0.91	0.91

Category	Items
Adherence to the anticoagulant therapy’s dose scheme	1-5; 11-13; 15-21; 23-30
Blood collection for the oral anticoagulant monitoring exam (INR)	14
Consumption of foods that interfere with the anticoagulant	1-3; 6-7
Concerns about the occurrence of adverse effects caused by the treatment	3; 5; 8; 10; 12; 15; 22
Drug interaction with warfarin	9
Effectiveness of pharmacotherapy	17-18; 20; 22-26; 29-30
“Others” (Understanding and satisfaction with treatment)	19

Characteristics	Sample (no. = 30)
Sex, no. (%)
Female	15 (50.0%)
Male	15 (50.0%)
Average age in years (standard deviation)	61.7 (±14.5)
Age (years), n (%)
< 45	5 (16.7%)
45-60	10 (33.3%)
61-75	7 (23.3%)
≥ 76	8 (26.7%)
Education, n (%)
No education	2 (6.7%)
Incomplete Elementary School	15 (50.0%)
Complete Elementary School	7 (23.3%)
High School	5 (16.7%)
College	1 (3.3%)

[1] Mailing Address: Hannah Cardoso Barbosa • Av. Pres. Antônio Carlos, 6627. Postal Code 31270-901, Pampulha, Belo Horizonte, MG – Brazil E-mail: hannahcbarbosa@gmail.com

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Construction and Validation of a Protocol Targeting Patients on Oral Anticoagulation with Warfarin

Abstract

Background

Objective

Methods

Results

Conclusion