Research and clinical trials have shown that instructing patients on how to use their medications produces positive long-term results, both emotionally and physically. The knowledge heightens their level of responsibility and has a significant impact on the effectiveness of their medication. "Empowering patients by having them participate in managing their medical treatment adds an important layer to the quality of their treatment,” says Prof. Mayer Brezis, head of the Center for Clinical Quality and Safety at the Hadassah University Medical Center. “The more information patients have and the greater role they take in managing their medical treatment, the more successful the outcome."
Coumadin, the world’s most prescribed anticoagulant, is a proven case in point, which is why the Hadassah Center produced an instruction manual for patients who must take this medication to maintain the proper clotting level of their blood.
While still in the hospital, patients are taught how to monitor their blood’s clotting level and select the appropriate dosage. Upon release, they receive two kits – one for themselves and one for their family doctor. The kits contain a colorful, illustrated brochure about Coumadin in Hebrew, Arabic, Russian or English; a special ruler for finding the exact dosage according to most recent blood test; simple software to help calculate the optimal dose; and medical literature on the self-monitoring of oral anticoagulants for the family doctor.
With Prof. Brezis’ guidance, Dr. Chanan Goldberg, a graduate of the Hebrew University-Hadassah School of Medicine, created the kit as a thesis project for his medical degree. Dr. Goldberg is currently serving as a physician in Israel Defense Forces paratrooper corps.
An estimated six million people worldwide take anticoagulants for a variety of reasons or diseases – and Coumadin, also known by its generic name Warfarin, is the most popular. About 40,000 people in Israel take Coumadin. For the medication to be safe and efficient, the dosage must be correct and the patients’ clotting system kept balanced. The clotting system is measured in International Ratio units (INR) that must be within one of two ranges: 2.0-3.0 or 2.5-3.5. Only one-third of the patients who take anticoagulants stay within the correct range; all others are at risk of bleeding from overdosage, or of clotting from underdosage.
Research both abroad and at Hadassah now shows that empowering patients to self-management remarkably improves efficacy and safety of anticoagulation.
Hadassah's patients responded enthusiastically to the new Coumadin kits, the first instruction manuals of their kind in Israel. Israel's medical community was positively impressed and Israeli HMOs expressed interest in using the kits.
Lois Gordon of Hadassah’s Center for Safety and Clinical Quality edited and designed the kits as well as the innovative ruler. Yochi Ben David, RN, led the project from its start at Department of Cardiac Surgery at Hadassah and was in charge of the training of patients. Family physician Dr. Tuvia Baevsky, Klalit Sick Fund, developed the special software for calculating dosages.
More information can be found at the Center's website: www.hadassah.org.il/departments/quality
under Projects: Safer oral anticoagulation