Patient satisfaction with extended-interval warfarin monitoring

Abstract

Extended-interval monitoring of warfarin has been proposed to reduce follow-up burden and improve patient satisfaction. We aimed to make an initial assessment of anticoagulation satisfaction before and after an extended-interval warfarin monitoring intervention. We conducted a translational prospective single-arm pilot study of extended-interval warfarin monitoring in five pharmacist-managed anticoagulation clinics. Patients meeting CHEST guideline criteria for extended-interval warfarin monitoring began progressive extended-interval follow-up (6, 8, and 12 weeks thereafter). The Duke Anticoagulation Satisfaction Scale (DASS) was administered at baseline and at end-of-study or study removal (in patients no longer appropriate for extended interval follow-up). Forty-six patients had evaluable pre- and post-intervention DASS survey data. Mean age of patients was 66.5 years, 74 % were non-Hispanic whites, and 48 % were men. Patients completed a mean ± SD of 34 ± 22 weeks of follow-up. Mean ± SD total DASS score at baseline was 45.2 ± 14.2 versus 49.1 ± 14.9 at end-of-study (mean change, +3.9 [95 % CI -0.6-8.4; p = 0.09]), indicating no benefit-and trending toward decrement-to anticoagulation satisfaction. Change in anticoagulation satisfaction varied substantially following extended-interval monitoring, with no evidence of improved satisfaction. Plausible reasons for patients not preferring extended-interval monitoring include increased anxiety and disengagement from self-management activities, both potentially related to less frequent feedback and reassurance during extended interval-monitoring. Additional research is needed to identify who is likely to benefit most from extended-interval monitoring. Anticoagulation satisfaction should be considered with clinical factors and shared-decision making when implementing extended-interval warfarin monitoring.

WITHDRAWN: Pharmacist-led interventions might improve quality of life among older adult patients receiving warfarin treatment in rural areas: results from a randomized controlled trial

“…According to these authors, patients who switch from conventional care to the self-care model after 2 years have a significantly higher QoL, probably because they are less dependent on going to the doctor. In contrast, Carris et al found that anticoagulation satisfaction following extended interval monitoring, as measured by the DASS questionnaire, did not change or may have marginally worsened after an extended interval follow up, which was contrary to expectations [16]. The authors suggest that less frequent feedback and patient-provider interaction might have resulted in reduced patient perception of benefit from anticoagulation and reduced self-management activities [16].…”

Barriers and facilitators to reducing frequent laboratory testing for patients who are stable on warfarin: a mixed methods study of de-implementation in five anticoagulation clinics

“…One other health system has published their experience with a similar de-implementation effort to reduce frequent INR tests among patients with stable warfarin control [16, 17]. However, they did not report on how frequently their staff scheduled the next INR test more than the standard 4 weeks into the future for eligible patients or the barriers and facilitators to their de-implementation effort.…”

Assessment of adherence to medication for cardiovascular diseases: measurement tools

“…The questionnaire has been extensively used with patients with AF or other diseases requiring anticoagulant treatment. [31][32][33][34][35] It has been translated into Brazilian Portuguese, and the cultural validation demonstrated very good psychometric properties (Cronbach's α = 0.79). 36 In some studies, the Duke questionnaire was used as a quality-of-life measure, and the authors demonstrated that dissatisfaction with anticoagulant treatment contributed to lower adherence, worse INR control and worse clinical outcomes.…”