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Al Ayoubi F, Al Mashali M, Abdallah MH, Al Sheef M, Owaidah T. Position Statement on In-hospital/Clinic Point-of-care Coagulation Testing for Anticoagulation Monitoring in Saudi Arabia. J Saudi Heart Assoc 2023; 35:290-300. [PMID: 38116402 PMCID: PMC10727136 DOI: 10.37616/2212-5043.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/14/2023] [Accepted: 10/07/2023] [Indexed: 12/21/2023] Open
Abstract
Objectives Hospital overload is a persistent occurrence in daily practice. Interventions such as point-of-care testing (POCT) are needed to alleviate the pressure faced by healthcare providers and administrators. Methods An invited panel of experts from Saudi Arabia was formed under the auspices of the Saudi Heart Association in order to discuss local treatment gaps in the management of patients receiving anticoagulation therapy. This was done in a series of meetings, which resulted in the development of official recommendations for the implementation of POCT for anticoagulation monitoring in the country. Recommendations were based on a comprehensive literature review and international guidelines taking into consideration local clinical practice, clinical gaps, and treatment/testing availabilities. Results Vitamin K antagonist (VKA)-based anticoagulation therapy requires routine monitoring. POCT is a promising model of care for the monitoring of International Normalized Ratio (INR) in patients receiving oral anticoagulation in terms efficacy, safety and convenience. The availability of POC INR testing should not replace the use of standard laboratory anticoagulation monitoring. However, there are several indications for implementing POCTINR monitoring that was agreed upon by the expert panel. POCT for anticoagulation monitoring should primarily be used in the warfarin (or other VKA) monitoring clinic in order to ensure treatment efficiency, cost-effectiveness of care, patient satisfaction, and quality of life improvement. The expert panel detailed the requirements for the establishment of a warfarin (or other VKA) monitoring clinic in terms of organization, safety, quality control, and other logistic and technical considerations. The limitations of POCT should be recognized and recommendations on best practices should be strictly followed. Core laboratory confirmation should be sought for patients with higher INR results (>4.7) on POCT. Proper training, quality control, and regulatory oversight are also critical for preserving the accuracy and reliability of POCT results. Conclusions POCT enables more rapid clinical decision-making in the process of diagnosis (rule-in or rule-out), treatment choice and monitoring, and prognosis, as well as operational decision-making and resource utilization. POCT thus can fulfill an important role in clinical practice, particularly for patients receiving VKAs.
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Affiliation(s)
- Fakhr Al Ayoubi
- College of Medicine, King Saud University Medical City, Riyadh,
Saudi Arabia
| | - Malak Al Mashali
- Head of Point of Care Division, Prince Sultan Military Medical City, Riyadh,
Saudi Arabia
| | | | - Mohamed Al Sheef
- Medical Specialties Department, King Fahad Medical City, Riyadh,
Saudi Arabia
| | - Tarek Owaidah
- King Faisal Specialty Hospital and Al-Faisal University, Riyadh,
Saudi Arabia
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Ryu R, Bahjri K, Tran H. Potential Association of Holidays on Internationalized Normalized Ratio in Warfarin-Users at a Multidisciplinary Clinic. Cardiol Res 2023; 14:38-44. [PMID: 36896230 PMCID: PMC9990547 DOI: 10.14740/cr1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/06/2023] [Indexed: 02/27/2023] Open
Abstract
Background Warfarin is approved by the United States Food and Drug Administration for numerous clinical indications. The effectiveness of warfarin is highly dependent on the time-in-therapeutic range based on the international normalized ratio (INR) goal, which may be altered by changes in diet, alcohol intake, concomitant drugs, and travel, all of which are prevalent during the holidays. At this time, there are no published studies assessing the impact of holidays on INR in warfarin-users. Methods A retrospective chart review was conducted on all adult patients taking warfarin and managed at a multidisciplinary clinic. Patients were included if they were taking warfarin at home regardless of indication for anticoagulation. The INR pre- and post-holiday was assessed. Results Of a total of 92 patients, the mean age was 71.5 ± 14.3 years, and most patients were on warfarin with an INR goal of 2 - 3 (89%). There were significant differences in INR before and after Independence Day (2.55 vs. 2.81, P = 0.043) and Columbus Day (2.39 vs. 2.82, P < 0.001). The remaining holidays showed no significant differences in INR before and after each respective holiday. Conclusions There may be factors related to Independence and Columbus Day that are increasing the level of anticoagulation in warfarin-users. Although the mean post-holiday INR values, in essence, maintained within the typical target of 2 - 3, our study underscores the specialized care that is warranted in higher risk patients to prevent a continued increase in INR and subsequent toxicities. We hope our results would be hypothesis-generating and aid in the development of larger, prospective evaluations to validate the findings of our present study.
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Affiliation(s)
- Rachel Ryu
- Western University of Health Sciences College of Pharmacy, Pomona, CA 91766, USA
| | - Khaled Bahjri
- Loma Linda University School of Pharmacy, Loma Linda, CA 92350, USA
| | - Huyentran Tran
- Loma Linda University School of Pharmacy, Loma Linda, CA 92350, USA
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Almesned A, Alqwaee A, Abusiryeh B, Almeman A. Decentralization and Virtualization of INR-based Anticoagulation Control During the COVID-19 Pandemic. Cardiovasc Hematol Disord Drug Targets 2023; 23:177-182. [PMID: 37921213 DOI: 10.2174/011871529x242935231026105854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/13/2023] [Accepted: 08/31/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To investigate the effectiveness of the decentralization and virtualization of anticoagulation clinics just before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS We conducted a cohort study investigation at Prince Sultan Cardiac Clinics PSCC Qassim region, Saudi Arabia. To evaluate the effectiveness of the virtual coagulation clinic, we calculated the time in therapeutic range (TTR), Morisky score for adherence, and satisfaction. Demographics of the patients were analyzed to group patients based on their regions or districts to facilitate the visits. Thirteen different PHCs/Hospitals were allocated for decentralization based on patient density in that region. Intensive courses were provided for all general practitioners (GPs) regarding warfarin anticoagulation and point of care testing (POCT) using iSTAT. All appointments were scheduled by WhatsApp, with no more actual visits to the main center. RESULTS Among the included participants (n = 5616), 61.1% were females, 38.9% were males, and the mean age was 60.5 (18-85) years. The total number of clinic visits was 7303 per month, with an average of 1.3 visits per patient. Approximately 95% of the participants had a valvular indication to receive anticoagulation; of them, 55% underwent mitral valve replacement. Moreover, after the virtualization of the INR clinic, keeping INR levels within a therapeutic range was reported in 80% of patients. Regarding patient satisfaction, 90% of the total population was satisfied by the new experience. CONCLUSION Decentralization and virtualization of the INR clinic have similar TTR results if conducted properly.
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Affiliation(s)
- Abdulrahman Almesned
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Maternity and Children Hospital, Buraidah, Al Qassim, Saudi Arabia
| | - Abdullah Alqwaee
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Maternity and Children Hospital, Buraidah, Al Qassim, Saudi Arabia
| | - Bayan Abusiryeh
- Nurse, Prince Sultan Cardiac Center, Maternity and Children Hospital, Buraidah, Al Qassim, Saudi Arabia
| | - Ahmad Almeman
- Clinical Pharmacy Department, College of Medicine, Qassim University, Saudi Arabia
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Reynolds NR, Baker D, D'Aoust R, Docal M, Goldstein N, Grubb L, Hladek MD, Koirala B, Kverno K, Ling C, Lukkahatai N, McIltrot K, Pandian V, Regier NG, Sloand E, Tomori C, Wenzel J. COVID-19: Implications for Nursing and Health Care in the United States. J Nurs Scholarsh 2023; 55:187-201. [PMID: 36583656 PMCID: PMC9847252 DOI: 10.1111/jnu.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE COVID-19 and other recent infectious disease outbreaks have highlighted the urgency of robust, resilient health systems. We may now have the opportunity to reform the flawed health care system that made COVID-19 far more damaging in the United States (U.S.) than necessary. DESIGN AND METHODS Guided by the World Health Organization (WHO) Health System Building Blocks framework (WHO, 2007) and the socio-ecological model (e.g., McLeroy et al., 1988), we identified challenges in and strengths of the U.S.' handling of the pandemic, lessons learned, and policy implications for more resilient future health care delivery in the U.S. Using the aforementioned frameworks, we identified crucial, intertwined domains that have influenced and been influenced by health care delivery in the U.S. during the COVID-19 pandemic through a review and analysis of the COVID-19 literature and the collective expertise of a panel of research and clinical experts. An iterative process using a modified Delphi technique was used to reach consensus. FINDINGS Four critically important, inter-related domains needing improvement individually, interpersonally, within communities, and for critical public policy reform were identified: Social determinants of health, mental health, communication, and the nursing workforce. CONCLUSIONS The four domains identified in this analysis demonstrate the challenges generated or intensified by the COVID-19 pandemic, their dynamic interconnectedness, and the critical importance of health equity to resilient health systems, an effective pandemic response, and better health for all. CLINICAL RELEVANCE The novel coronavirus is unlikely to be the last pandemic in the U.S. and globally. To control COVID-19 and prevent unnecessary suffering and social and economic damage from future pandemics, the U.S. will need to improve its capacity to protect the public's health. Complex problems require multi-level solutions across critical domains. The COVID-19 pandemic has underscored four interrelated domains that reveal and compound deep underlying problems in the socioeconomic structure and health care system of the U.S. In so doing, however, the pandemic illuminates the way toward reforms that could improve our ability not only to cope with likely future epidemics but also to better serve the health care needs of the entire population. This article highlights the pressing need for multi-level individual, interpersonal, community, and public policy reforms to improve clinical care and public health outcomes in the current COVID-19 pandemic and future pandemics, and offers recommendations to achieve these aims.
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Affiliation(s)
- Nancy R. Reynolds
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Deborah Baker
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Rita D'Aoust
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Maria Docal
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Nancy Goldstein
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Lisa Grubb
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Melissa D. Hladek
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Binu Koirala
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Karan Kverno
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Catherine Ling
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Nada Lukkahatai
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Kimberly McIltrot
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Vinciya Pandian
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Natalie G. Regier
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Elizabeth Sloand
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Cecília Tomori
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Jennifer Wenzel
- Sigma Theta Tau International Nu Beta at‐Large ChapterSchool of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
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Evaluation of a pharmacist-led drive-up anticoagulation clinic during the coronavirus 2019 pandemic. J Am Pharm Assoc (2003) 2022. [PMCID: PMC9531932 DOI: 10.1016/j.japh.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background The University of Kentucky HealthCare Anticoagulation Clinic at the Gill Heart and Vascular Institute in Lexington, Kentucky, designed and implemented a drive-up clinic for warfarin management with the goal to minimize person-to-person exposure during the coronavirus disease 2019 (COVID-19) pandemic. Objective The purpose of this study was to evaluate the effect on warfarin management in a pharmacist-led anticoagulation service when transitioned from an in-person clinic to a drive-up clinic during the COVID-19 pandemic. Methods This is a retrospective observational cohort study of 68 patients seen in the University of Kentucky HealthCare Anticoagulation Clinic on warfarin therapy for any indication. Patients were included if they had scheduled visits at least 3 times in the period 6 months before, during, and after the initiation of the drive-up clinic. The primary outcome is the difference in time in therapeutic range (TTR) before and during the drive-up clinic. Results The difference between the mean TTR in period 1 (69.1% ± 23.2%) and period 2 (69.6% ± 19.2%) was not statistically significant (P = 0.882). The mean TTR in period 3 (70.5% ± 20.8%) did not differ in statistical significance from either period 1 (P = 0.688) or period 2 (P = 0.746). Safety outcomes including reported bleeding events and emergency department visits or hospital admissions for bleeding or thrombotic events were consistently low across each period. Conclusion The results of this study illustrate that a drive-up clinic for warfarin management may be a reasonable alternative approach to providing care for outpatient anticoagulant management and may support nontraditional clinic models for long-term management of anticoagulation and other chronic disease states.
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Efficacy and safety of app-based remote warfarin management during COVID-19-related lockdown: a retrospective cohort study. J Thromb Thrombolysis 2022; 54:20-28. [PMID: 35092566 PMCID: PMC8799972 DOI: 10.1007/s11239-021-02630-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 12/14/2022]
Abstract
This study aimed to explore the effectiveness, and safety of internet-based warfarin management during the pandemic. In this single-center retrospective cohort study, we compared the safety and efficacy of online warfarin management using a smartphone app (the Alfalfa app) versus conventional outpatient clinic management from January 1, 2020 to March 31, 2020. Patients in the online management group used the Alfalfa app to communicate coagulation test results and other relevant information to a doctor or clinical pharmacist, who then responded with the dose adjustment plan and the date of the next blood test. The outcomes examined were the time in therapeutic range (TTR), incidence of clinical events (i.e., bleeding events, thrombotic events, warfarin-related emergency department visits, and warfarin-related hospital admissions), and the distribution of international normalized ratio (INR) values. Data from 117 patients were analyzed in this study. TTR was significantly higher in the online group than in the offline group (61.0% vs. 39.6%, P < 0.01). Incidence of major bleeding events, thrombotic events, and warfarin-related hospital admissions were comparable between the online and offline groups. However, minor bleeds (5.3% vs. 28.3%, P < 0.01) and warfarin-related emergency department visits (1.8% vs. 23.3%, P = 0.02) were significantly fewer in the online group than in the offline group. The proportion of INR values in the therapeutic range (53.8% vs. 40.1%, P < 0.01) was significantly higher in the online group. Warfarin management using the Alfalfa app appears to be a safe and effective method for warfarin management when patients cannot physically visit hospitals for follow-up.
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Juodvalkis A, Carroll K, Eash T, Foster T, Bentfield B. Assessment of Curbside Anticoagulation Pharmacy Visits on Clinical Outcomes and Patient Satisfaction. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Kacey Carroll
- Ascension St. Vincent Indianapolis Indiana
- Butler University College of Pharmacy and Health Sciences Indianapolis Indiana
| | - Toni Eash
- Ascension St. Vincent Indianapolis Indiana
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Al-Husban N, Alnsour LN, El-Adwan Z, Saleh NA, El-Zibdeh M. Impact of Pregnancy-Related Venous Thromboembolism on Quality of Patients' Lives. Clin Appl Thromb Hemost 2021; 27:10760296211040873. [PMID: 34747226 PMCID: PMC8573690 DOI: 10.1177/10760296211040873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: During pregnancy, the risk of venous thrombo-embolism (VTE) is increased at least five times compared with non-pregnant women of the same age, while the relative risk in the postpartum period can be as high as sixty times. The aim of the study was to explore the impact of pregnancy-related VTE on patients' mental, professional, social and personal life. Methods and Materials: Cross-sectional study at Jordan University Hospital's Obstetrics Department. Results: There were 112 women. Forty-six (41.1%) had a postpartum VTE. Twenty-eight of the patients (25%) had comorbidity. Eleven (9.9%) had a previous episode of VTE. Thirty-nine (35%) of the women reported three or more hospital visits over the past six months. Twenty-one (19.6%) of the women answered that their leg or chest pain has impeded their social activities. Anxiety/Depression was reported by 96.43% while Pain/Discomfort by 73.21%. A significant reduction of time spent on their work (correlation = 0.663, significant at <0.01) and accomplishing less work (correlation = 0.787, this was significant at <0.01) was found; 57.14% of patients indicated that VTE affecting their future pregnancies; 58.9% of patients were receiving anticoagulants with the most commonly used drug was aspirin. Twenty-four (36.4%) of the women were on multiple anticoagulant therapies. Twenty-five of the patients receiving medications do not monitor their medications and 20 patients said that monitoring the drug level was a bother to them. Conclusions: Pregnancy-related VTE had a significant adverse impact on physical, mental and professional life of women. It also had negative effects on future pregnancy plans.
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Giver J, Dunn AL, Sankar A, Stanek J, Monda K, Canini J, Kerlin BA, Rodriguez V. Drive-through Anticoagulation Clinic During The COVID-19 Pandemic. J Nurse Pract 2021; 18:92-96. [PMID: 34512214 PMCID: PMC8423809 DOI: 10.1016/j.nurpra.2021.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
An innovative approach to anticoagulation management during the COVID-19 pandemic was used at our center that allowed patients to stay in their vehicle while our anticoagulation advanced practice registered nurse obtained blood for point-of-care international normalized ratio (INR) testing while education and counseling were completed. A significant improvement in the median percentage of INR within the therapeutic range was observed among the patients who used the drive-through clinic. A small group of patients improved compliance to anticoagulation monitoring. Clinical care models, such as this clinic approach may improve patient compliance and adherence to anticoagulation beyond the pandemic needs.
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Affiliation(s)
- Jean Giver
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus OH
| | - Amy L Dunn
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Amanda Sankar
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Joseph Stanek
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus OH
| | - Kay Monda
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus OH
| | - Joan Canini
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus OH
| | - Bryce A Kerlin
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Vilmarie Rodriguez
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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Alhmoud EN, Abd El Samad OB, Elewa H, Alkhozondar O, Soaly E, El Anany R. Drive-up INR testing and phone-based consultations service during COVID-19 pandemic in a pharmacist-lead anticoagulation clinic in Qatar: Monitoring, clinical, resource utilization, and patient- oriented outcomes. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY : JACCP 2021; 4:1117-1125. [PMID: 34226887 PMCID: PMC8242871 DOI: 10.1002/jac5.1469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022]
Abstract
Background Coronavirus disease 2019 (COVID‐19) pandemic has resulted in unprecedented pressure on healthcare systems and led to widespread utilization of telemedicine or telehealth services. Combined with teleclinics, using drive‐up fingerstick International normalized ratio (INR) testing was recommended to decrease exposure risk of anticoagulation patients. Objective To evaluate the impact of transitioning from clinic‐based anticoagulation management services to drive‐up and phone‐based services during COVID‐19 pandemic in Qatar. Methods The study comprised of two components: a retrospective cohort study of all eligible patients who attended anticoagulation clinic over 1‐year period (6 months before and 6 months after service transition) and a cross‐sectional survey of eligible patients who agreed to provide data about their satisfaction with the new service. Monitoring parameters, clinical outcomes, and resource utilization related to warfarin therapy were compared before and after service transition. Patients' experience was explored through a structured survey. Results There was no statistically significant difference between clinic‐based and phone‐based anticoagulation services in mean time and number of visits within therapeutic range (P = .67; P = .06 respectively); mean number of extreme subtherapeutic and supratherapeutic INR values (P = .32 and P = .34, respectively); incidence of thromboembolic complications and warfarin related hospitalization. There was one reported bleeding and one emergency visit (0.9%) in the phone‐based group vs none in the clinic‐based group. Frequency of INR testing and compliance to attending clinics appointments declined significantly (P = .002; P = .001, respectively). Overall, patients were highly satisfied with the new service. The majority of patients found it better (51.6%) or just as good as the traditional service (44.5%). Patients who preferred the new service were significantly younger than their counterparts (P = .005). Conclusion The service of drive‐up INR testing and phone‐based consultations was shown to be comparable to traditional anticoagulation service, a finding that supports maintaining such services as part of the new normal after the pandemic is over.
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Affiliation(s)
| | | | - Hazem Elewa
- College of Pharmacy, QU Health Qatar University Doha- Qatar
| | | | - Ezeldin Soaly
- Al Wakra Hospital Hamad Medical Corporation Doha Qatar
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