Appointment attendance and patient perception of drive‐up INR testing in a rural anticoagulation clinic during the COVID‐19 pandemic

Zobeck, Bryan; Carson, Erin; MacDowell, Martin; Hunt, Aaron T.; Reeder, Austin

doi:10.1002/jac5.1390

Cited by 10 publications

(3 citation statements)

References 10 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Likewise, Zobeck and colleagues evaluated patient perceptions of curbside INR visits during the COVID-19 pandemic and found that while half of the patients had no preference or preferred to be seen inside the clinic, the other half preferred the curbside visits. 10 However, these data are difficult to compare with the data presented from this study because there were different questions posed on the survey.…”

Section: Discussionmentioning

confidence: 83%

Assessment of curbside anticoagulation pharmacy visits on clinical outcomes and patient satisfaction

Juodvalkis

Carroll

Eash

et al. 2022

J Am Coll Clin Pharm

View full text Add to dashboard Cite

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, curbside international normalized ratio (INR) checks were implemented to monitor patients on warfarin therapy. Because of the lack of available data, clinical outcomes and patient satisfaction were assessed to determine if the implementation of curbside visits could be considered as an alternative to the standard of care.Objectives: The objectives were to assess clinical outcomes, safety, and patient satisfaction in a patient cohort whose anticoagulation was managed inside the clinic in 2019 compared with the same patients managed in the curbside setting in 2020.Methods: In this retrospective study, INR time in therapeutic range (TTR) was used as a marker for clinical appropriateness of anticoagulation therapy. Data were also prospectively collected in the form of patient satisfaction surveys.Adverse events and hospitalizations were assessed to ensure patient safety was not omitted. Results:The median TTR in 2019 was significantly higher than in 2020, 95.7% (interquartile range [IQR] 33.3%) vs 84.3% (IQR 45.2%) (z = À3.99, P < .001). Clinically, the mean TTR remained higher in 2019 than in 2020 (81.3% vs 74.7%). Less patients experienced bleeding events in 2020, and there was an average of 1 less visit per patient in 2020 compared with 2019. Surveys indicated that more patients would like their visits to occur inside the clinic if there were no concerns for a pandemic. Conclusion:Anticoagulation management assessed by TTR was significantly lower in the 2020 time frame compared with 2019; however, the average TTR in both time frames was above the clinically accepted threshold of adequate anticoagulation control. Patients demonstrated favor toward in-person visits unless there were concerns for a pandemic. If needed, curbside visits could be considered in the future at this site; however, more studies would need to be done to assess the impact of curbside visits at other institutions.

show abstract

Section: Discussionmentioning

confidence: 83%

Assessment of curbside anticoagulation pharmacy visits on clinical outcomes and patient satisfaction

Juodvalkis

Carroll

Eash

et al. 2022

J Am Coll Clin Pharm

View full text Add to dashboard Cite

show abstract

“…Telehealth or telemedicine became a method of choice for most consultations (Klapper et al, 2021; Newman‐Casey et al, 2021; Williams et al, 2021). “Drive‐thru” and curbside clinics were used to provide care for patients who needed in‐person treatment (Halalau et al, 2020; Zobeck et al, 2021).…”

Section: Resultsmentioning

confidence: 99%

COVID‐19: Implications for Nursing and Health Care in the United States

Reynolds

Baker

D’Aoust

et al. 2022

J of Nursing Scholarship

View full text Add to dashboard Cite

PurposeCOVID‐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 MethodsGuided 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.FindingsFour 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.ConclusionsThe 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 relevanceThe 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.

show abstract

“…Patients should be inquired about detailed holiday/ travel plans to prevent any overlooked interactions that may have additive effects on INR. The vicinity of the INR draw can be made close to each holiday, perhaps by way of self-monitoring, telephone/remote monitoring, or drive-up methods [29][30][31]. Achieving therapeutic levels of INR in warfarin-users is indispensable in yielding favorable clinical outcomes, such as reducing rates of stroke, systemic embolism, bleeding, hospitalization, and mortality [1][2]6].…”

Section: Discussionmentioning

confidence: 99%

Potential Association of Holidays on Internationalized Normalized Ratio in Warfarin-Users at a Multidisciplinary Clinic

2023

View full text Add to dashboard Cite

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.

show abstract

Appointment attendance and patient perception of drive‐up INR testing in a rural anticoagulation clinic during the COVID‐19 pandemic

Cited by 10 publications

References 10 publications

Assessment of curbside anticoagulation pharmacy visits on clinical outcomes and patient satisfaction

Assessment of curbside anticoagulation pharmacy visits on clinical outcomes and patient satisfaction

COVID‐19: Implications for Nursing and Health Care in the United States

Potential Association of Holidays on Internationalized Normalized Ratio in Warfarin-Users at a Multidisciplinary Clinic

Contact Info

Product

Resources

About