title: Transition of stable patients from traditional anticoagulation clinic services to telephonic management.
abstract: Background Outpatient warfarin dosing and monitoring with telephonic anticoagulation management (TAM) could be an effective alternative to other more labor intensive management models. Objectives To evaluate the time in therapeutic range (TTR) and number of extreme INR values (<1.5 or >4.5) of a telephonic system of warfarin management for stable patients who currently utilized traditional anticoagulation management services (AMSs). Method A retrospective, observational cohort with three groups (1) patients transitioned from an office-based anticoagulation clinic to TAM, (2) patients continuously enrolled in office-based AMS, (3) patients continuously managed by usual physician care without specialized anticoagulation services (UPC). Data was collected for six months before and six months after transition. Results All groups demonstrated decreased TTR from baseline to active phase, with the TAM and AMS groups showing similar magnitude of reduction (-10.61 and -12.66% respectively) but UPC group producing a greater drop (-20.08%). The TAM and AMS groups had similar rates of extreme INR levels; UPC had higher numbers of extreme INRs in three of the four measurements. Conclusion Stable patients transitioned from office-based anticoagulation clinic to a telephonic model of management performed equally as well as those who continued traditional enrollment.
authors.affiliation: Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA. bcryde@midwestern.edu.|Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA. bcryde@midwestern.edu.
authors.forename: Brian T
authors.identifier: http://orcid.org/0000-0003-2780-2751
authors.initials: BT
authors.lastname: Cryder
authors.affiliation: Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA.|Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Felczak
authors.affiliation: Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA.
authors.forename: Adwoa
authors.initials: A
authors.lastname: Darkwa
authors.affiliation: Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA.
authors.forename: Hiral
authors.initials: H
authors.lastname: Patel
authors.affiliation: Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA.
authors.forename: Justine D
authors.initials: JD
authors.lastname: Janociak
authors.affiliation: Advocate Medical Group, 9831 S. Western Ave, Chicago, IL, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Rihani
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D000554:Ambulatory Care Facilities; D000925:Anticoagulants / Q000008:administration & dosage* / Q000494:pharmacology; D015331:Cohort Studies; D006801:Humans; D019934:International Normalized Ratio; D010865:Pilot Projects; D012189:Retrospective Studies; D013689:Telephone; D014859:Warfarin / Q000008:administration & dosage* / Q000494:pharmacology
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Anticoagulation clinic; International normalized ratio; Pharmacist; Telehealth; United States; Warfarin