title: Telephone-based anticoagulation management in the homebound setting: a retrospective observational study.
abstract: BACKGROUND
  Anticoagulation 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Telephone-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.
authors.affiliation: Division of Internal Medicine; Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Hassan
authors.affiliation: Division of Internal Medicine; Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Naboush
authors.affiliation: Division of Internal Medicine; Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Radbel
authors.affiliation: Division of Internal Medicine; Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Razan
authors.initials: R
authors.lastname: Asaad
authors.affiliation: Division of Hematology/Oncology; Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Homam
authors.initials: H
authors.lastname: Alkaied
authors.affiliation: Division of Statistics; Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Seleshi
authors.initials: S
authors.lastname: Demissie
authors.affiliation: Division of Hematology/Oncology; Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Terenig
authors.initials: T
authors.lastname: Terjanian
keywords: INR; anticoagulation; anticoagulation clinic; homebound; telephone-based; warfarin