title: 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.
authors.affiliation: Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 30, Tampa, FL, 33612-4749, USA. carris@health.usf.edu.|Department of Family Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 30, Tampa, FL, 33612, USA. carris@health.usf.edu.
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Carris
authors.affiliation: Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, P.O Box 100486, Gainesville, FL, 32610, USA.|Department of Community Health and Family Medicine, College of Medicine, University of Florida, 1707 N. Main St., Gainesville, FL, 32609, USA.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Hwang
authors.affiliation: Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, P.O Box 100486, Gainesville, FL, 32610, USA.|Department of Community Health and Family Medicine, College of Medicine, University of Florida, 1707 N. Main St., Gainesville, FL, 32609, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, P.O Box 100486, Gainesville, FL, 32610, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Taylor
authors.affiliation: Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, P.O Box 100486, Gainesville, FL, 32610, USA.|Department of Community Health and Family Medicine, College of Medicine, University of Florida, 1707 N. Main St., Gainesville, FL, 32609, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Sando
authors.affiliation: Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, P.O Box 100486, Gainesville, FL, 32610, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Powell
authors.affiliation: Division of General Internal Medicine, College of Medicine, University of Florida, 2000 SW Archer Rd, 4th Floor, Suite 4592, Gainesville, FL, 32608, USA.
authors.forename: Eric I
authors.initials: EI
authors.lastname: Rosenberg
authors.affiliation: Division of Hematology/Oncology, College of Medicine, University of Florida, 2000 SW Archer Rd, 3rd Floor, Gainesville, FL, 32608, USA.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Zumberg
authors.affiliation: Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, P.O Box 100486, Gainesville, FL, 32610, USA.|Department of Community Health and Family Medicine, College of Medicine, University of Florida, 1707 N. Main St., Gainesville, FL, 32609, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Gums
authors.affiliation: Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, P.O Box 100486, Gainesville, FL, 32610, USA.|Department of Community Health and Family Medicine, College of Medicine, University of Florida, 1707 N. Main St., Gainesville, FL, 32609, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Dietrich
authors.affiliation: Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, P.O Box 100486, Gainesville, FL, 32610, USA.|Division of General Internal Medicine, College of Medicine, University of Florida, 2000 SW Archer Rd, 4th Floor, Suite 4592, Gainesville, FL, 32608, USA.
authors.forename: Katherine Vogel
authors.initials: KV
authors.lastname: Anderson
mesh_terms: D000368:Aged; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D014859:Warfarin / Q000008:administration & dosage* / Q000493:pharmacokinetics*
chemical_list: D014859:Warfarin
keywords: Anticoagulation; Interval; Monitoring; Patient satisfaction; Warfarin