Key result
Pharmacist face-to-face warfarin management achieved greater time in therapeutic range than telephone management with local labs (69.0% vs 60.5%, P=0.0032), but was similar to patient self-testing.
Why the study?
Does pharmacist face-to-face warfarin management improve INR time in therapeutic range compared to telephone-based management in patients on established warfarin therapy?
Observational (n=336)
Yes
Does pharmacist face-to-face warfarin management improve INR time in therapeutic range compared to telephone-based management in patients on established warfarin therapy?
Absolute Event Rate: 69% vs 60.5%
p-value: p=0.0032
Pharmacist-led face-to-face warfarin management and telephone-based management with patient self-testing achieve similar time in therapeutic range, both outperforming telephone management with local lab testing.
Face-to-face pharmacist warfarin management was associated with higher TTR than telephone; leaves open optimal strategy versus self-testing pending prospective data.
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.
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Lee et al. (2017) conducted an observational in Established warfarin therapy (n=336). Pharmacist face-to-face warfarin management vs. Telephone-based distance management (local laboratories or patient self-testing) was evaluated on International normalized ratio (INR) time in therapeutic range (TTR) (p=0.0032). Pharmacist face-to-face warfarin management achieved greater time in therapeutic range than telephone management with local labs (69.0% vs 60.5%, P=0.0032), but was similar to patient self-testing.
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