Journal article
Clinical and Financial Outcomes Evaluation of Multimodal Pharmacist Warfarin Management of a Statewide Urban and Rural Population
Journal of pharmacy practice, Vol.31(2), pp.150-156
04/01/2018
DOI: 10.1177/0897190017703506
PMID: 28441899
Abstract
Purpose: To evaluate the efficacy, safety, and indirect financial outcomes of pharmacist face-to-face warfarin management with telephone-based distance management utilizing local laboratories or patient self-testing (PST).
Methods: A retrospective analysis of a clinic population of 336 patients on established warfarin therapy distributed statewide in rural and urban settings over a 6-month period was conducted. Participants were stratified into face-to-face management, telephone-based management utilizing local laboratory testing, and telephone-based management utilizing PST.
Results: The primary outcome of international normalized ratio (INR) time in therapeutic range (TTR) for face-to-face management was significantly greater than distance management utilizing local laboratory testing (69.0% vs 60.5%, P = .0032). No difference was observed between face-to-face management and PST (69.0% vs 68.0%, P = .25). No significant difference in bleeding or thromboses was observed. Although increased clinician time was utilized during face-to-face encounters compared to telephone encounters (8.7-minute face-to-face, 5.5-minute local laboratory, and 5.4-minute PST), face-to-face encounters tended to be billable at lower levels, whereas telephone-based encounters were billable at higher levels.
Conclusion: A multimodal approach to pharmacist warfarin management of a patient population distributed statewide in rural and urban locations is effective despite TTR differences associated with INR testing used in distance management. PST may improve warfarin treatment outcomes and adherence in distance management, particularly when the use of alternative oral anticoagulants is inappropriate. Although time and billing differences between face-to-face and distance management exist, clinical and safety outcomes remain acceptable despite encounter complexity and support reimbursement of pharmacist anticoagulation management in all settings.
Details
- Title: Subtitle
- Clinical and Financial Outcomes Evaluation of Multimodal Pharmacist Warfarin Management of a Statewide Urban and Rural Population
- Creators
- James C. Lee - University of Illinois Hospital & Health Sciences SystemKathleen E. Horner - University of IowaMichelle L. Krummel - University of Iowa Hospitals and ClinicsDeanna L. McDanel - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of pharmacy practice, Vol.31(2), pp.150-156
- Publisher
- Sage
- DOI
- 10.1177/0897190017703506
- PMID
- 28441899
- ISSN
- 0897-1900
- eISSN
- 1531-1937
- Number of pages
- 7
- Language
- English
- Date published
- 04/01/2018
- Academic Unit
- Pharmacy Practice and Science; Internal Medicine
- Record Identifier
- 9984359856002771
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