EFFECTS OF PHARMACIST COUNSELING ON COMPLIANCE AND INR SCORE ON OUTPATIENTS RECEIVING WARFARIN AT DR. HASAN SADIKIN BANDUNG HOSPITAL WEST JAVA, INDONESIA

Abstract

Objective:Warfarin is a derivate of coumarin, which is usually prescribed as an oral anti-coagulant for treatment and prevention of thromboembolic disorders. The aim of presents research is analysis the influence of pharmacist counseling on complience and INR score recovery on warfarin management.

Methods:Design in this research used mixed method, combination ofqualitative and quantitative method. Qualitative data were used for completingquantitative data. Qualitative method used a content analysis with interview.Quantitative method used a quasi experimental method with control groups, pre test, and post test design. Data were analysed by wilcoxon test and mann whitney test at significance levelP ≤ 0,05 and multivariate analysis covariate.

Results:Data were collected from 80 patients with Rheumatic Heart Disease (42.5 %), Atrial Fibrilation (17.5 %), Deep Vein Thrombosis (10%), Rheumatic Mitral Valve Disease (10%), Prosthetic Heart (7.5%), other (22.5%). The numbers of patients whose International Normalized Ratio (INR) was in the therapeutic range for each indication were not statistically different between before and after receiving counseling (P >0.05), Patients' behavior compliance of warfarin therapy had increased after receiving the counseling service (P <0.05). The result of presents research is pharmacist counseling affected  behavior compliance before and after counseling(P <0.05), but not for INR (P >0.05).

Conclusion:Pharmacist counseling can improve behavior compliance, but not improve INR target. The effect of warfarin to every individual not only affected by behavior compliance, but several factors could influence effect of warfarin is clinical factors, non clinical factors, and genetic factors. Clinical factors that wereinfluenced were age, gender, pharmacokinetic and pharmacodynamic variability in patiens.