A Critique Presentation of the paper "Patient Attitudinal and Behavioral Factors Associated with Warfarin Non-adherence at Outpatient Anticoagulation Clinics" as part of the module "Research Methods" at the University of Hertfordshire for my third year of the MPharm degree. Dean G. Cruess & A. Russell Localio & Alec B. Platt & Colleen M. Brensinger & Jason D. Christie & Robert Gross & Catherine S. Parker & Maureen Price & Joshua P. Metlay & Abigail Cohen & Craig W. Newcomb & Brian L. Strom & Stephen E. Kimmel Published in the international Journal of Behavioural Medicine

1. Patient Attitudinal & Behavioural
Factors Associated with
WarfarinNon-Adherence at
Outpatient Anticoagulation Clinics
Critique Presentation
Amandeep Birdi
Dean G. Cruess, A. Russell Localio, Alec B. Platt, Colleen M. Brensinger, Jason D. Christie, Robert Gross, Catherine
S. Parker, Maureen Price, Joshua P. Metlay, Abigail Cohen, Craig W. Newcomb, Brian L. Strom, Stephen E. Kimmel

2. Why?
1. “patient factors underscore effective
warfarin use”
2. “Wide range of potential influences”
3. “Limited data on attitudinal and
behavioral factors”
Patient Attitudinal and Behavioral Factors Associated with Warfarin
Non-Adherence at Outpatient Anticoagulation Clinics

3. Led to the Aim…
“TO EXAMINE SPECIFIC PATIENT FACTORS
THAT MIGHT HELP EXPLAIN WARFARIN
NON-ADHERENCE AT OUTPATIENT
ANTICOAGULATION CLINICS”
Patient Attitudinal and Behavioral Factors Associated with Warfarin
Non-Adherence at Outpatient Anticoagulation Clinics
To find out the reasons why patients are
not adhering to their Warfarin when
they leave Anticoagulation Clinics

4. Method
• How did they…
– Measure Adherence?
• MEMS Pill Caps (Medication Event Monitoring
Systems)
– Measure Factors/Behavior?
• Million Behavioral Medicine Diagnostic
(MBMD)
Patient Attitudinal and Behavioral Factors Associated with Warfarin
Non-Adherence at Outpatient Anticoagulation Clinics

5. So…
• Hypothesis?
• A Clear Focused Issue?
– Population
• Who was excluded?
– Benefit VS Harms
– Outcomes
• Comparable? Answer question?
Patient Attitudinal and Behavioral Factors Associated with Warfarin
Non-Adherence at Outpatient Anticoagulation Clinics

6. Was the method appropriate for
the question?
Patient Attitudinal and Behavioral Factors Associated with Warfarin
Non-Adherence at Outpatient Anticoagulation Clinics
Therefore…

7. Results and Discussion
• What were the results?
– Adherence &non-adherence
– Relationship between MBMD & non-adherence?
• How reliable?
– Confidence levels
– Biased?
• Statistics
– Clearly show result?
Patient Attitudinal and Behavioral Factors Associated with Warfarin
Non-Adherence at Outpatient Anticoagulation Clinics

8. Conclusions
• Author’s conclusions
– “Lack of receptivity to details”
– Aim answered
• MY CONCLUSIONS
– Clear rationale
– Clinically relevant and significant result
– Further studies required in other clinical
settings
– Written and presented well
Patient Attitudinal and Behavioral Factors Associated with Warfarin
Non-Adherence at Outpatient Anticoagulation Clinics

9. Future Work
• Limitations?
– Other factors
– Use of Pill Caps
– Other clinic settings
• Work implied for future?
– Larger patient samples
Patient Attitudinal and Behavioral Factors Associated with Warfarin
Non-Adherence at Outpatient Anticoagulation Clinics

10. Thank you for listening!