Paper
Wednesday, 19 July 2006
This presentation is part of : Community Based Care Strategies
Upsetting the Apple Cart: A Community Anticoagulation Clinic Survey of Life Event Factors that Undermine Safe Therapy
Sarah Edmundson, MS1, Diane Stuenkel, EdD, RN2, and Phyllis M. Connolly, PhD, APRN, BC, CS2. (1) Critical Care & Anticoagulation Clinic, Dominican Hospital, Santa Cruz California, Catholic Healthcare West, Santa Cruz, CA, USA, (2) School of Nursing Faculty, San Jose State University, San Jose State University, San Jose, CA, USA
Learning Objective #1: State the potential impact of negative life events on clinic based anticoagulation therapy regulation.
Learning Objective #2: List two demographic factors found to be inversely associated with lower life event scores reported in this study.
Abstract
            Anticoagulation therapy is a life enhancing therapy for patients who are at risk for embolic events secondary to atrial fibrillation, valve replacement, and other co-morbidities. Clinicians are motivated to decrease the amount of time that patients are either sub-therapeutic or over-anticoagulated, common conditions that decrease patient safety at either extreme. The primary purpose of this descriptive study was to examine the relationship between personal life event factors as measured by Norbeck’s Life Events Questionnaire (LEQ), core demographics such as age and income, and anticoagulation regulation. While many factors affect anticoagulation therapy, the precise impact of life events, positive or negative, is unknown. The salient findings of this study (n = 202) showed a small, though statistically significant inverse relationship (r = -.184, p = <0.01), between negative life events and decreased time within therapeutic international normalized ratio (INR).  Total life events scores showed a statistically significant inverse relationship (r = -.159, p = <0.05) to INR time within therapeutic level. Lower income was inversely associated with higher negative life events scores (r = -.192, p = <0.01). The findings demonstrate the need for strategies that address the potential impact of life events in conjunction with coexisting screening measures used in anticoagulation clinics. Implications for this study are limited by lack of methodology documenting concurrent social support factors, and limitations of the research tool to reflect life event issues specific to outpatient seniors.

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