Transition of stable patients from traditional anticoagulation clinic services to telephonic management

Cryder, Brian T.; Felczak, Margaret A.; Darkwa, Adwoa; Patel, Hiral S.; Janociak, Justine D.; Rihani, Rami S.

doi:10.1007/s11096-017-0428-4

Cited by 13 publications

(27 citation statements)

References 10 publications

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“…However, a study by Lee et al revealed opposite results [26]. Some studies have reported similar TTR between online anticoagulation management and regular medical care [27][28][29]. This study showed that the rates of subtherapeutic, supratherapeutic, and extreme subtherapeutic INR values were significantly lower in the Alfalfa app group than in the offline warfarin management group.…”

Section: Discussionmentioning

confidence: 59%

See 1 more Smart Citation

Effectiveness of the Alfalfa App in Warfarin Therapy Management for Patients Undergoing Venous Thrombosis Prevention and Treatment: Cohort Study

Cao¹,

Jiang²,

Lv³

et al. 2021

JMIR Mhealth Uhealth

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Background Over the years, the internet has enabled considerable progress in the management of chronic diseases, especially hypertension and diabetes. It also provides novel opportunities in online anticoagulation management. Nevertheless, there is insufficient evidence regarding the effectiveness of online anticoagulation management. Objective This study explored the effectiveness and safety of warfarin management via the Alfalfa app, so as to provide evidence in support of anticoagulant management through online services. Methods In this retrospective, observational cohort study, 824 patients were included. In the offline group, patients went to the hospital clinic for warfarin management. In the Alfalfa app group, patients reported the dose of warfarin, current international normalized ratio (INR) value, and other related information through the Alfalfa app. Physicians or pharmacists used the app to adjust the dose of warfarin and determined the time for the next blood INR testing. Patients completed INR testing by point-of-care at home or hospital. The primary outcome of the study was the percentage of time in therapeutic range (TTR). Secondary outcomes included minor and major bleeding events, thrombotic events, warfarin-related emergency department visits, hospital admissions, and high INR values. Results The TTR and percentage of INR values in the range were significantly higher in the Alfalfa app group than in the offline group (79.35% vs 52.38%, P<.001; 3314/4282, 77.39% vs 2005/4202, 47.72%, P<.001, respectively). Patients managed via the Alfalfa app had lower rates of subtherapeutic (172/4282, 4.02% vs 388/4202, 9.23%; P<.001), supratherapeutic (487/4282, 11.37% vs 882/4202, 20.99%; P<.001), and extreme subtherapeutic INR values (290/4282, 6.77% vs 910/4202, 21.66%; P<.001). Additionally, the Alfalfa app group had lower incidences of major bleeding (2/425, 0.5% vs 12/399, 3.0%; P=.005), warfarin-related emergency department visits (13/425, 3.1% vs 37/399, 9.3%; P<.001), and hospital admissions (1/425, 0.2% vs 12/399, 3.0%; P=.001) compared with the offline group. However, the Alfalfa app group had a higher incidence of minor bleeding than the offline group (45/425, 10.6% vs 20/399, 5.0%; P=.003). There were similar incidences in extreme supratherapeutic INR values (19/4282, 0.44% vs 17/4202, 0.40%; P=.78) and thromboembolic events (1/425, 0.2% vs 1/399, 0.3%; P=.53) between the two groups. Conclusions Warfarin management is superior via the Alfalfa app than via offline services in terms of major bleeding events, warfarin-related emergency department visits, and hospital admissions.

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Section: Discussionmentioning

confidence: 59%

“…The studies by Xia et al and Cryder et al showed that there were fewer anticoagulation-related hospital admissions in the online anticoagulation group [4,27]. Most studies have reported that there are no differences in the incidence of major bleeding events between the two groups [5,[27][28][29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of the Alfalfa App in Warfarin Therapy Management for Patients Undergoing Venous Thrombosis Prevention and Treatment: Cohort Study

Cao¹,

Jiang²,

Lv³

et al. 2021

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

show abstract

“…Results from studies with multiple intervention or comparator groups were analyzed as separate comparisons. 12,17 All statistical analyses were completed using StatsDirect Version 3.2.8 (StatsDirect Ltd, Merseyside, England).…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

“…Of the 1125 initial citations, 18 full text articles were screened for eligibility, and 11 studies involving 8395 patients were ultimately included in the systematic review (Table 1). 12,13,15,[17][18][19][20][21][22][23][24] One study was a randomized controlled trial, 22 whereas 10 were retrospective observational studies. 12,13,15,[17][18][19][20][21]23,24 All but 1 study 19 were conducted in the United States.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…12,13,15,[17][18][19][20][21][22][23][24] One study was a randomized controlled trial, 22 whereas 10 were retrospective observational studies. 12,13,15,[17][18][19][20][21]23,24 All but 1 study 19 were conducted in the United States. In all, 10 of the studies evaluated TP services managed by clinical pharmacists, whereas 1 study 12 was conducted at a clinic that is staffed with clinical pharmacists and registered nurses.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Effectiveness of Telepharmacy Versus Face-to-Face Anticoagulation Services in the Ambulatory Care Setting: A Systematic Review and Meta-analysis

et al. 2020

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Background: Effectiveness of anticoagulation services managed via telepharmacy (TP) has not been clearly demonstrated. Objective: This systematic review and meta-analysis compares the effectiveness of TP anticoagulation services to face-to-face (FTF) anticoagulation services in the ambulatory care setting. Methods: A literature search for studies assessing the effectiveness of TP services was conducted using PubMed, EMBASE, and Cochrane Central databases, from inception through November 18, 2020. Studies that compared TP with FTF anticoagulation services in the ambulatory care setting were included. Outcomes of interest included thromboembolic events, major bleeding, minor bleeding, any bleeding, warfarin international normalized ratio (INR) time in therapeutic range (TTR), frequency of extreme INR, anticoagulation-related emergency department visits, anticoagulation-related hospitalization, any hospitalization, and mortality. Relative risk (RR) and weighted mean difference were calculated using the DerSimonian and Laird random-effects model. Results: Overall, 11 studies involving 8395 patients were included in the systematic review, and 9 studies were included in the pooled meta-analysis. Compared with FTF service, TP was associated with a lower risk of any bleeding and any hospitalization, with RRs of 0.65 (95% CI = 0.47 to 0.90; P = 0.01) and 0.59 (95% CI = 0.39 to 0.87; P = 0.01), respectively. There was no statistically significant difference in TTR or the risk of extreme supratherapeutic INR, major bleeding, minor bleeding, or thromboembolic events between the 2 groups. Conclusions: TP appears to be at least as effective as FTF anticoagulation services. Findings from this study support the utilization of TP practice models in ambulatory care anticoagulation management.

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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

Alhmoud

Samad

Elewa

et al. 2021

J Am Coll Clin Pharm

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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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Transition of stable patients from traditional anticoagulation clinic services to telephonic management

Cited by 13 publications

References 10 publications

Effectiveness of the Alfalfa App in Warfarin Therapy Management for Patients Undergoing Venous Thrombosis Prevention and Treatment: Cohort Study

Effectiveness of the Alfalfa App in Warfarin Therapy Management for Patients Undergoing Venous Thrombosis Prevention and Treatment: Cohort Study

Effectiveness of Telepharmacy Versus Face-to-Face Anticoagulation Services in the Ambulatory Care Setting: A Systematic Review and Meta-analysis

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

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