title: Telephone versus office-based management of warfarin: impact on international normalized ratios and outcomes.
abstract: Studies have concluded that telephone-based management of warfarin is an effective alternative to in-office management. High rates of patient and physician satisfaction have been reported with telephone-based monitoring. Proposed benefits of telephone-based monitoring include time- and cost savings for patients and healthcare providers alike as well as increased access to care for those patients who have difficulty making in-office appointments. This study aimed to evaluate the impact of telephone versus office-based management of warfarin on extreme INR values. A retrospective cohort study was conducted to assess outcomes of patients receiving warfarin managed either by telephone or in-office appointments. The primary endpoint of the study was the frequency of extreme INR values, defined as an INR ≤1.5 or ≥4.5. A total of 110 patients were evaluated; subjects were distributed 2:1 between the in-office and telephone groups. Baseline characteristics were similar between groups. Subjects followed via telephone had a twofold increase in the incidence of extreme INR values compared to the patients followed in-office (15.18 vs. 7.98 %; p < 0.0001). Overall TTR was similar between groups (85.39 vs. 80.38 %, p = 0.1171). There was no difference between the two groups in the incidence of major bleeding events (2.67 vs. 0 %, p = 1.00), thromboembolic events (8 vs. 0 %, p = 0.1740), or hospitalizations related to anticoagulation therapy (6.67 vs. 0 %, p = 0.1758). Patients monitored via telephone had a higher incidence of extreme INR values than patients followed in-office, which may lead to an increased incidence of adverse outcomes in the long-term. Well-designed, prospective studies are needed to confirm such findings.
authors: Department of Pharmacy, Saint Thomas Rutherford Hospital, Murfreesboro, TN, USA.
authors: Laura G
authors: LG
authors: Stoudenmire
authors: Christina E
authors: CE
authors: DeRemer
authors: Hazem
authors: H
authors: Elewa
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D019468:Disease Management; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017216:Telemedicine / Q000706:statistics & numerical data*; D013689:Telephone; D013923:Thromboembolism / Q000517:prevention & control* / Q000523:psychology; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin