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Impact of an extended International Normalized Ratio follow-up interval on healthcare use among veteran patients on stable warfarin doses.

Authors
  • Margolis, Amanda R1
  • Porter, Andrea L1
  • Staresinic, Carla E2
  • Ray, Cheryl A2
  • 1 University of Wisconsin-Madison School of Pharmacy, Madison, WI, and William S. Middleton Memorial Veterans Hospital, Madison, WI.
  • 2 William S. Middleton Memorial Veterans Hospital, Madison, WI.
Type
Published Article
Journal
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
Publication Date
Oct 30, 2019
Volume
76
Issue
22
Pages
1848–1852
Identifiers
DOI: 10.1093/ajhp/zxz209
PMID: 31589272
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To analyze the impact of a 12-week extended International Normalized Ratio (INR) follow-up interval on healthcare use. A prospective cohort study of the use of an extended INR follow-up interval of up to 12 weeks was conducted over 2 years in a pharmacist-managed anticoagulation clinic. A detailed protocol was used to extend the INR follow-up interval to 5-6 weeks and then 7-8 weeks and 11-12 weeks. The number of planned and unplanned anticoagulation encounters, procedures requiring warfarin interruption, telephone triage phone calls, emergency department visits, and hospitalizations were collected. A post hoc subanalysis was also completed on participants who were scheduled for 4 consecutive 12-week intervals. Compared to baseline, at 12 months there was a mean decrease in planned anticoagulation encounters of 2.24 visits (p < 0.001) among 44 participants. From 12 to 24 months compared to baseline, there was a mean decrease in planned anticoagulation encounters of 3.13 visits (p < 0.001) and an increase of 0.54 unplanned anticoagulation encounters (p = 0.04) among 39 participants. The remainder of healthcare use variables were not statistically significantly different from baseline at any time point. Of the 15 participants scheduled for 4 consecutive 12-week intervals, there was a decrease from baseline of approximately 5 visits over the course of a year (p < 0.001). An extended INR follow-up interval appears to decrease anticoagulation healthcare use without an increase in acute healthcare use. While this intervention could be cost-effective, institutions need to consider safety, efficacy, and feasibility prior to implementation. Published by Oxford University Press on behalf of the American Society of Health-System Pharmacists 2019.

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