1. Educating Patients about Atrial Fibrillation EBP Research Project Auburn University/Auburn Montgomery Location: Thomasville Internal Medicine Tonya Anderson, BSN, RN, Graduate Student, PCNP

2. Outline PICO Question Purpose Significance Summary of Evidence Method Sample Findings Summary

3. PICO Question In patients with atrial fibrillation, how does individualized education rather than generalized education affect the patient ability to adhere to medication?

4. Purpose Evaluate and increase medication adherence Educate Increase follow-up Increase the self-management of AF Decrease hospital stays

5. Significance Atrial Fibrillation(AF) is the most common cardiac arrhythmia in the United States (Shea and Sears, 2011) AF has significant complications if not managed Stroke Dementia Heart Failure Death Anticoagulant has serious complications if not properly regulated. Patient knowledge and participation in AF management leads to fewer hospital stays and decrease healthcare costs.

6. Summary of Evidence Databases: CINHAL, ERIC, HeathSource, Medline, PsycInfo, and PsycArticles. Six studies found Review of research shows a lack of knowledge in patients with Atrial Fibrillation, medication, and treatment. Research suggests that improved outcomes are guided by education and involvement in care.

7. Method Thomasville Internal Medicine. Consents for eight patients. Morisky Medication Adherence Scale given prior to education and by follow-up phone call. Data collected- Age, gender, and race. Education received: Atrial Fibrillation, risks of uncontrolled HR, Coumadin, and rate control medications. All data was compiled and analyzed.

8. Sample Eight participants Diagnosis of atrial fibrillation Take Coumadin and a rate control medication

9. Findings: Questionnaire -- The lower the number, the higher the compliance. -- Results may range from 0 to 11.

10. Findings The Morisky Medication Adherence Scale (Morisky, Krousel-Wood, & Ward, 2008)

11. Summary Findings suggest: -Although the participants reported high medication compliance at baseline, improvement was noted. -The improvement was not statistically significant. - A larger sample size is warranted with a longer evaluation period is needed to evaluate the significance of education in atrial fibrillation patients.

12. References Kring, D.L. (2008). Clinical nurse specialist practice domains and evidence-based practice competencies. Clinical Nurse Specialist, 22(4), 179- 183. Morsiky, A., Krousel-Wood, M. Ward, H. (2008). Predictive validity of a medication adherence measure for hypertension control. Journal of Clinical Hypertension 10(5), 348-354. Shea, J., & Sears, S. (2008). A patient’s guide to living with atrial fibrillation. Circulation 11, e340-e343. doi: 10.1161/CIRCULATIONAHA.108.780577

13. Questions???