1
|
Lopez SE, Lim RXT. Comparing the effectiveness, safety and cost of teleconsultation versus face-to-face model of pharmacist-led anticoagulation clinic: A single institution experience. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:334-337. [PMID: 38920228 DOI: 10.47102/annals-acadmedsg.2023281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Teleconsultation-based (TELE) anticoagulation clinic (ACC) is an alternative modality, but its use in Singapore’s clinical setting has not been well studied. In Tan Tock Seng Hospital (TTSH), the TELE ACC service was established to enrol patients who (1) perform self-testing using a loaned point-of-care (POC) international normalised ratio (INR) coagulometer or (2) visit the nearest polyclinic for INR blood test on days instructed by an ACC pharmacist; the patients will be followed up with via telephone consult or video conference on the same day. This enables patient convenience and reduces patient wait time compared with face-to-face (F2F) consultation.
Collapse
|
2
|
Al Ammari M, AlThiab K, AlJohani M, Sultana K, Maklhafi N, AlOnazi H, Maringa A. Tele-pharmacy Anticoagulation Clinic During COVID-19 Pandemic: Patient Outcomes. Front Pharmacol 2021; 12:652482. [PMID: 34566632 PMCID: PMC8459665 DOI: 10.3389/fphar.2021.652482] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/05/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: It is well-established that clinical pharmacist-managed anticoagulation services achieve superior anticoagulation control, with a positive impact. At King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, the structure of anticoagulation management is a pharmacist-managed specialty service. With the current COVID-19 situation, measures were taken to assure the continuity of patient care by establishing tele-pharmacy anticoagulation clinics. Materials and Methods: This was a prospective study with patients prescribed anticoagulation and followed up for 3 months. Since establishing the anticoagulation virtual clinic in March 2020, 270 patients were recruited in the study. The data collected included age, gender, comorbidities, indication for anticoagulation, intended duration of treatment, warfarin dose, testing of International Normalized Ratio (INR), INR target, range of INR values, time INR that was within the therapeutic range (TTR), and complications of therapy (bleeding and/or bruises). The patients were asked to complete the pharmacist satisfaction survey (PSS) after their consultation to assess patient satisfaction with the new virtual consultation system. Linguistic and cultural validation was conducted for the questionnaire. Results: A total of 270 patients were included in the study. The mean percentage of overall INR values in the range was 59.39% ± 32.84, and the mean time with the overall INR was within the therapeutic range 57.81% ± 32.08. Thirty-one percent of the sample had good anticoagulation control (time in therapeutic range >70%). The median satisfaction score was 32 (IQR 28-36) with a maximum score of 40. Conclusion: This is the first study to assess the tele-pharmacy anticoagulation clinic's efficiency and patient satisfaction in Saudi Arabia during the COVID-19 pandemic. This type of consultation was as effective as face-to-face consultations. The study also highlighted that though the reduction in the cost of care was not substantial, there was a significant increase in resource (clinical pharmacist) utilization as a result of this model. The adoption of tele-pharmacy resulted in time savings for the clinical pharmacists who can be utilized in many other improvement projects in adult ambulatory clinics to ensure the delivery of better quality and safe patient care.
Collapse
Affiliation(s)
- Maha Al Ammari
- Department of Pharmacy Service, King Abdul Aziz Medical City (KAMC), Riyadh, Saudi Arabia
- Ministry Of National Guard Health Affair(MNGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Khalefa AlThiab
- Department of Pharmacy Service, King Abdul Aziz Medical City (KAMC), Riyadh, Saudi Arabia
- Ministry Of National Guard Health Affair(MNGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Manal AlJohani
- Department of Pharmacy Service, King Abdul Aziz Medical City (KAMC), Riyadh, Saudi Arabia
- Ministry Of National Guard Health Affair(MNGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Khizra Sultana
- Ministry Of National Guard Health Affair(MNGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Nada Maklhafi
- Department of Pharmacy Service, King Abdul Aziz Medical City (KAMC), Riyadh, Saudi Arabia
- Ministry Of National Guard Health Affair(MNGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Hayel AlOnazi
- Department of Pharmacy Service, King Abdul Aziz Medical City (KAMC), Riyadh, Saudi Arabia
- Ministry Of National Guard Health Affair(MNGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Aswaq Maringa
- Department of Pharmacy Service, King Abdul Aziz Medical City (KAMC), Riyadh, Saudi Arabia
- Ministry Of National Guard Health Affair(MNGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Saw Y, Yap SY, Tan YH. Evaluation of the clinical and safety outcomes of
face‐to‐face
vs a telephonic model of a
pharmacist‐led
outpatient anticoagulation service. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Yashi Saw
- National University Hospital Singapore Singapore
| | - Shi Yin Yap
- National University Hospital Singapore Singapore
| | - Yu Heng Tan
- National Healthcare Group Woodlands Health Campus Yishun Singapore
| |
Collapse
|
4
|
Sakunrag I, Danwilai K, Dilokthornsakul P, Chaiyakunapruk N, Dhippayom T. Clinical Outcomes of Telephone Service for Patients on Warfarin: A Systematic Review and Meta-Analysis. Telemed J E Health 2020; 26:1507-1521. [PMID: 32213010 DOI: 10.1089/tmj.2019.0268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: To evaluate clinical outcomes of telephone-based service for patients on warfarin. Methods: Five bibliographic databases and gray literature were searched for articles that reported the effects of telephone interventions provided to patients using warfarin compared with those receiving usual clinic-based care. Mean difference (MD) and relative risk (RR) were used to calculate the effects of telephone intervention on time in therapeutic range (TTR) and visit in range (VIR), respectively. Adverse events (AEs) were pooled and reported as incidence rate ratios. Results: A total of 1,840 articles were examined. Eight articles involving 8,087 subjects were included in the quantitative synthesis. The pooled estimates from seven studies showed no difference on TTR between the telephone service group and the usual care group (MD 2.30; 95% confidence interval [CI] -3.56 to 8.16). In addition, VIR in the telephone service group was not different from the usual care group (RR 1.22, 95% CI 0.87-1.71). Moreover, patients in telephone service groups appeared to have a lower incidence of AEs compared with usual care groups. Discussion: Telephone-based service could be considered as an alternative anticoagulant management. However, owing to a lack of evidence from well-designed studies, further high-quality randomized control trials are warranted.
Collapse
Affiliation(s)
- Itsarawan Sakunrag
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Kwanjit Danwilai
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Piyameth Dilokthornsakul
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Teerapon Dhippayom
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| |
Collapse
|
5
|
Yiu A, Bajorek B. Patient-focused interventions to support vulnerable people using oral anticoagulants: a narrative review. Ther Adv Drug Saf 2019; 10:2042098619847423. [PMID: 31205676 PMCID: PMC6535713 DOI: 10.1177/2042098619847423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 04/01/2019] [Indexed: 12/18/2022] Open
Abstract
The aim of this review was to identify patient-focused interventions that have been trialed to support vulnerable patient populations taking oral anticoagulants (warfarin and the direct-acting oral anticoagulants (DOACs)) such as older persons (65 years and over), those with limited health literacy, and those from culturally and linguistically diverse (CALD) backgrounds. This review also aimed to report on the effects of these interventions on outcomes relevant to the use of anticoagulant therapy. Original articles published between 1 January 1995 and 30 June 2017 were identified using several electronic databases such as Medline, Ovid, Embase, Scopus, Cochrane, and Google Scholar. The following terms were used for the three-tiered search: Tier 1, elderly, aged, older adult, geriatrics; Tier 2, health literacy, literacy, low health literacy, low English proficiency, patient literacy; and Tier 3, ethnicity, ethnic, ethnic groups, CALD, culturally and linguistically diverse, NESB, non-English speaking background, race, racial groups, religion, religious groups, and minority groups. The terms for each tier were combined with the following terms: anticoagulants, anticoagulation, warfarin, apixaban, dabigatran, rivaroxaban, DOACS, new oral anticoagulants, novel oral anticoagulants, patient care, patient knowledge, comprehension, patient education, patient participation, and communication. A total of 41 studies were identified. Most of the interventions identified included older persons taking warfarin who were monitored using the international normalized ratio (INR) and who received patient education. Many interventions reported a significant positive impact on patients' knowledge, reduction in the number of adverse events caused by hemorrhage, and better INR control. More research on patient-focused interventions is needed that includes patients with limited health literacy, those from CALD backgrounds, and family members and caregivers of patients taking oral anticoagulants.
Collapse
Affiliation(s)
- Angela Yiu
- Graduate School of Health – Pharmacy, University Technology of Sydney, Level 4, Building 7, 67 Thomas Street, Ultimo, NSW 2007, Australia
| | - Beata Bajorek
- Graduate School of Health – Pharmacy, University of Technology Sydney and Pharmacy Department, Royal North Shore Hospital, Australia
| |
Collapse
|
6
|
Sudas Na Ayutthaya N, Sakunrak I, Dhippayom T. Clinical Outcomes of Telemonitoring for Patients on Warfarin after Discharge from Hospital. Int J Telemed Appl 2018; 2018:7503421. [PMID: 30158972 PMCID: PMC6109538 DOI: 10.1155/2018/7503421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/13/2018] [Accepted: 07/26/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the impact of telephone follow-up service on clinical outcomes in patients on warfarin when discharged from hospital. METHODS This randomized controlled trial was conducted at a general hospital in Thailand. Patients aged ≥20 years who were prescribed warfarin when discharged were eligible to participate in this study. They were randomly allocated, using a computer generated random number, to receive either telephone follow-up intervention or usual care. Participants in the intervention group received telephone follow-up by hospital pharmacists for three months. During each telephone call, pharmacists performed medicine use reviews and addressed any problems identified. KEY FINDINGS A total of 50 patients participated in this study. The proportion of international normalized ratio (INR) values in the target range for the telephone follow-up group (36/79, 45.6%) was higher than that in the usual care group (19/79, 24.1%), p=0.005. The mean time in the therapeutic range (TTR) in the telephone follow-up group was also higher than that in the usual care group (49.8±34.3 versus 28.0±27.5, p=0.017). All patients in the usual care group experienced one or more out-of-range INR values (25/25, 100%) compared to 21 out of 25 (84%) in the telephone follow-up group, p=0.037. There was no difference between the two groups in the incidence of complications or adverse events associated with warfarin. CONCLUSIONS The telephone follow-up service in recently discharged patients helps them achieve and maintain their INR target. This anticoagulant supportive service should be promoted to patients receiving warfarin therapy after discharge. This trial is registered with TCTR20180614006 (Thai Clinical Trials Registry).
Collapse
Affiliation(s)
- Natthaporn Sudas Na Ayutthaya
- Department of Pharmacy, Kamphaeng Phet Hospital, Mueang Kamphaeng Phet, Thailand
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Itsarawan Sakunrak
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Teerapon Dhippayom
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| |
Collapse
|
7
|
Outcomes of warfarin therapy managed by pharmacists via hospital anticoagulation clinic versus online anticoagulation clinic. Int J Clin Pharm 2018; 40:1072-1077. [PMID: 29956134 DOI: 10.1007/s11096-018-0674-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 06/14/2018] [Indexed: 12/25/2022]
Abstract
Background In response to the recognized difficulty in the management of patients on anticoagulation therapy, anticoagulation management services were developed in both hospital anticoagulation clinics (HACs) and an online anticoagulation clinic (OAC) by a pharmacist. Objective To compare monitoring outcomes and complications of warfarin therapy managed by pharmacists via hospital or on-line. Setting The anticoagulation clinic of Fujian Medical University Union Hospital, China. Method A retrospective, observational cohort study was used to compare patients managed via hospital to those managed o-line between December 2015 and 2016. The primary outcome was the percentage of time in the therapeutic range (TTR). The secondary outcomes were the incidence rates of hemorrhagic events, thrombotic events and extreme international normalized ratio (INR) values. Results A total of 152 patients were evaluated; 70 patients managed in a HAC were compared to 82 patients managed via an OAC. There were no significant differences in the TTR (78.9 vs. 74.0%, P = 0.393) and adverse events [major bleeding events (0 vs. 1.2%, P = 1.000), minor bleeding events (10.0 vs. 9.8%, P = 0.960), thromboembolic events (0 vs. 0%, P = 1.000), warfarin-related emergency visits (2.9 vs. 3.7%, P = 1.000)], warfarin-related hospital admissions (0 vs. 1.2%, P = 1.000), and the incidence of subtherapeutic (3.0 vs. 3.8%, P = 0.148), and extreme total (8.4 vs. 5.8%, P = 0.135), between the groups managed via HAC and OAC. Patients managed in the HAC were more stable on warfarin, with a higher percentage of INR values within the target therapeutic range (80.2 vs. 71.9%, P = 0.005) and a lower incidence of supratherapeutic INR values (8.4 vs. 18.5%, P = 0.001) compared to patients managed via OAC. Conclusion The management of oral anticoagulation therapy on-line yielded similar clinical outcomes compared to that achieved by management via the hospital, although the incidence of supra-therapeutic INR values was increased.
Collapse
|
8
|
Cryder BT, Felczak MA, Darkwa A, Patel H, Janociak JD, Rihani R. Transition of stable patients from traditional anticoagulation clinic services to telephonic management. Int J Clin Pharm 2017; 39:569-572. [PMID: 28361456 DOI: 10.1007/s11096-017-0428-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 01/17/2017] [Indexed: 10/19/2022]
Abstract
Background Outpatient warfarin dosing and monitoring with telephonic anticoagulation management (TAM) could be an effective alternative to other more labor intensive management models. Objectives To evaluate the time in therapeutic range (TTR) and number of extreme INR values (<1.5 or >4.5) of a telephonic system of warfarin management for stable patients who currently utilized traditional anticoagulation management services (AMSs). Method A retrospective, observational cohort with three groups (1) patients transitioned from an office-based anticoagulation clinic to TAM, (2) patients continuously enrolled in office-based AMS, (3) patients continuously managed by usual physician care without specialized anticoagulation services (UPC). Data was collected for six months before and six months after transition. Results All groups demonstrated decreased TTR from baseline to active phase, with the TAM and AMS groups showing similar magnitude of reduction (-10.61 and -12.66% respectively) but UPC group producing a greater drop (-20.08%). The TAM and AMS groups had similar rates of extreme INR levels; UPC had higher numbers of extreme INRs in three of the four measurements. Conclusion Stable patients transitioned from office-based anticoagulation clinic to a telephonic model of management performed equally as well as those who continued traditional enrollment.
Collapse
Affiliation(s)
- Brian T Cryder
- Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA. .,Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA.
| | - Margaret A Felczak
- Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA.,Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA
| | - Adwoa Darkwa
- Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA
| | - Hiral Patel
- Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA
| | | | - Rami Rihani
- Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA
| |
Collapse
|
9
|
Kelly K, Bradley J, Demesse KMA, Nguyen LU, Kelly KC, Allen AY. Anticoagulation Management Outcomes in Veterans: Office vs Telephone Visits. Fed Pract 2017; 34:37-40. [PMID: 30766256 PMCID: PMC6372025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Patients on anticoagulation therapy who transitioned to telephone visits from office visits showed no change in therapeutic outcomes.
Collapse
Affiliation(s)
- Katherine Kelly
- is a clinical pharmacy specialist in hematology/oncology, is an anticoagulation pharmacist, and are ambulatory care pharmacists, is a pharmacoeconomics pharmacist, and is an anticoagulation program manager, all at VA North Texas Health Care System in Dallas
| | - Jessica Bradley
- is a clinical pharmacy specialist in hematology/oncology, is an anticoagulation pharmacist, and are ambulatory care pharmacists, is a pharmacoeconomics pharmacist, and is an anticoagulation program manager, all at VA North Texas Health Care System in Dallas
| | - Kidest-Mimi A Demesse
- is a clinical pharmacy specialist in hematology/oncology, is an anticoagulation pharmacist, and are ambulatory care pharmacists, is a pharmacoeconomics pharmacist, and is an anticoagulation program manager, all at VA North Texas Health Care System in Dallas
| | - Lisa U Nguyen
- is a clinical pharmacy specialist in hematology/oncology, is an anticoagulation pharmacist, and are ambulatory care pharmacists, is a pharmacoeconomics pharmacist, and is an anticoagulation program manager, all at VA North Texas Health Care System in Dallas
| | - Kevin C Kelly
- is a clinical pharmacy specialist in hematology/oncology, is an anticoagulation pharmacist, and are ambulatory care pharmacists, is a pharmacoeconomics pharmacist, and is an anticoagulation program manager, all at VA North Texas Health Care System in Dallas
| | - April Y Allen
- is a clinical pharmacy specialist in hematology/oncology, is an anticoagulation pharmacist, and are ambulatory care pharmacists, is a pharmacoeconomics pharmacist, and is an anticoagulation program manager, all at VA North Texas Health Care System in Dallas
| |
Collapse
|
10
|
Haga SB, Allen LaPointe NM, Moaddeb J. Challenges to integrating pharmacogenetic testing into medication therapy management. J Manag Care Spec Pharm 2015; 21:346-52. [PMID: 25803768 PMCID: PMC4522310 DOI: 10.18553/jmcp.2015.21.4.346] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Some have proposed the integration of pharmacogenetic (PGx) testing into medication therapy management (MTM) to enable further refinement of treatments to reduce risk of adverse responses and improve efficacy. PGx testing involves the analysis of genetic variants associated with therapeutic or adverse response and may be useful in enhancing the ability to identify ineffective and/or harmful drugs or drug combinations. This "enhanced" MTM might also reduce patient concerns about side effects and increase confidence that the medication is effective, addressing 2 key factors that impact patient adherence: concern and necessity. However, the feasibility and effectiveness of the integration of PGx testing into MTM in clinical practice has not yet been determined. In this commentary, we consider some of the challenges to the integration and delivery of PGx testing in MTM services.
Collapse
Affiliation(s)
- Susanne B Haga
- Duke University School of Medicine, 304 Research Dr., Box 90141, Durham, NC 27708.
| | | | | |
Collapse
|
11
|
Blissit KT, Mullenix ML, Brittain KG. Evaluation of Time in Therapeutic Range on Warfarin Therapy Between Face-to-Face and Telephone Follow-Up in a VA Medical Center. J Pharm Technol 2015; 31:78-83. [PMID: 34860994 DOI: 10.1177/8755122514552497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Few studies have evaluated percent time in therapeutic range (TTR) for warfarin managed via face-to-face (FF) to telephone (TELE) visits-all finding no difference between groups. Objective: Compare and evaluate TTR for warfarin in patients who received pharmacist-managed care via FF or TELE. Methods: Single-center, retrospective study. Eligible participants were ≥18 years old, on indefinite warfarin therapy, followed by clinical pharmacists via FF or TELE from 2010 to 2012. Primary outcome (TTR) calculated via Rosendaal method. Event data included rates of any bleeding, significant bleeding, deep vein thrombosis, pulmonary embolism, cerebrovascular accident, hospitalizations, and death. Clinics were also compared by location. Results: Two hundred subjects (90 FF and 110 TELE) were included. Mean TTR was 68.17% and 69.57% in FF and TELE groups, respectively. The FF group had statistically significant higher rates of any bleeding (48.9% vs 30.9%). Rates of significant bleeding in FF versus TELE were not significantly different (6.67% vs 2.73%). The majority followed FF with significant bleeding were at a higher bleeding risk than those followed via TELE. There were low rates of venous thromboembolism (1.1% and 1.8%). Conclusions: TTR was ≥65% for most subjects with minimal variability in TTR between clinics. Mean TTR results for each group were greater and above the threshold that has been commonly described in the literature as quality control, suggesting a progression in implementation of telephone-based anticoagulation management.
Collapse
Affiliation(s)
- Katie T Blissit
- William Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
| | | | - Kevin G Brittain
- William Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
| |
Collapse
|