Outcomes of Oral Anticoagulant Therapy Managed by Telephone vs In-Office Visits in an Anticoagulation Clinic Setting

Wittkowsky, Ann K.; Nutescu, Edith A.; Blackburn, Juan C.; Mullins, Jennifer F.; Hardman, Jennifer; Mitchell, Jessica; Vats, Vikrant

doi:10.1378/chest.130.5.1385

Cited by 57 publications

(59 citation statements)

References 21 publications

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“…The studies did not find a difference in TTR between these 2 groups. [16][17] Within the Veterans Affairs (VA) health care system, the role and responsibilities of a pharmacist has expanded and continues to change, with one example being the centralization of pharmacist-managed anticoagulation. Successful implementation of telephone clinics in the VA would allow centralization of anticoagulation clinics within the outpatient pharmacy, which has historically been a function of team-based clinical pharmacists.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Time in Therapeutic Range on Warfarin Therapy Between Face-to-Face and Telephone Follow-Up in a VA Medical Center

Blissit

Mullenix

Brittain

2014

Journal of Pharmacy Technology

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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.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Time in Therapeutic Range on Warfarin Therapy Between Face-to-Face and Telephone Follow-Up in a VA Medical Center

Blissit

Mullenix

Brittain

2014

Journal of Pharmacy Technology

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“…Spending is lowered by reducing the utilization of medical resources, including clinic visits, hospital admissions, lengths of stay, and intensive care unit (ICU) days 8. Specifically, when used in the anticoagulation clinic, this approach reduces the risk of anticoagulation therapy-related complications and is at least as effective as in-person visits to manage oral anticoagulation 9,10. Additionally, patients have reported a high degree of satisfaction 11…”

Section: Introductionmentioning

confidence: 99%

Telephone-based anticoagulation management in the homebound setting: a retrospective observational study

Hassan¹,

Naboush²,

Radbel³

et al. 2013

IJGM

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BackgroundAnticoagulation management is currently performed through anticoagulation clinics or self-managed with or without the help of medical services. Homebound patients are a unique population that cannot utilize anticoagulation clinics or self-testing. Telephone-based anticoagulation management could be an alternative to the traditional methods of monitoring warfarin in this subgroup. The objective of this retrospective, observational study is to investigate the feasibility of warfarin management in homebound patients.MethodsThis study was performed through the use of telephone-based adjustments of warfarin dose based on an international normalized ratio (INR) result. Four hundred forty-eight homebound patients referred to the anticoagulation clinic at Staten Island University Hospital were visited at home by a phlebotomist; a blood sample was drawn for initial laboratory testing. A nurse practitioner then called the patient or designated person to relay the INR result and to direct dosage adjustment. INR results and dosage changes were entered into an electronic medical record and analyzed statistically.ResultsThe mean percentage of INR values in range was 58.39%. The mean time when the INR was in the therapeutic range was 62.75%. The percent of patients who were therapeutically controlled decreased as the number of medications increased. The complication rate was 4% per patient year, with an equal distribution between bleeding and clotting. These values compared favorably to other studies in which monitoring was performed through anticoagulation clinics or self-monitoring. The cost per visit at our anticoagulation clinic was found to be approximately $300 compared with $82 when utilizing our homebound service.ConclusionTelephone-based management of warfarin therapy in the homebound setting is feasible. It can lower the cost of health care expenditures compared to other modalities of anticoagulation management.

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“…These results expand and complement those of other published studies utilizing services (i.e., telephone, self-management) to monitor anticoagulation patients. 6,8,9 The telephone anticoagulation service implemented at HHS repurposed clinical staff pharmacists with primary distributive functions to serve a clinical role. This transition from distributive to clinical functions is important if our profession is to meet the objectives of the PPMI summit.…”

Section: Discussionmentioning

confidence: 99%

Expansion of clinical pharmacy through increased use of outpatient pharmacists for anticoagulation services

Philip

Green

Hoffman

et al. 2015

American Journal of Health-System Pharmacy

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Outcomes of Oral Anticoagulant Therapy Managed by Telephone vs In-Office Visits in an Anticoagulation Clinic Setting

Cited by 57 publications

References 21 publications

Evaluation of Time in Therapeutic Range on Warfarin Therapy Between Face-to-Face and Telephone Follow-Up in a VA Medical Center

Evaluation of Time in Therapeutic Range on Warfarin Therapy Between Face-to-Face and Telephone Follow-Up in a VA Medical Center

Telephone-based anticoagulation management in the homebound setting: a retrospective observational study

Expansion of clinical pharmacy through increased use of outpatient pharmacists for anticoagulation services

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