Abstract
Objective: To investigate the effectiveness of the decentralization and virtualization of anticoagulation clinics just before and during the coronavirus disease 2019 (COVID-19) pandemic.
Methods: We conducted a cohort study investigation at Prince Sultan Cardiac Clinics PSCC Qassim region, Saudi Arabia. To evaluate the effectiveness of the virtual coagulation clinic, we calculated the time in therapeutic range (TTR), Morisky score for adherence, and satisfaction. Demographics of the patients were analyzed to group patients based on their regions or districts to facilitate the visits. Thirteen different PHCs/Hospitals were allocated for decentralization based on patient density in that region. Intensive courses were provided for all general practitioners (GPs) regarding warfarin anticoagulation and point of care testing (POCT) using iSTAT. All appointments were scheduled by WhatsApp, with no more actual visits to the main center.
Results: Among the included participants (n = 5616), 61.1% were females, 38.9% were males, and the mean age was 60.5 (18-85) years. The total number of clinic visits was 7303 per month, with an average of 1.3 visits per patient. Approximately 95% of the participants had a valvular indication to receive anticoagulation; of them, 55% underwent mitral valve replacement. Moreover, after the virtualization of the INR clinic, keeping INR levels within a therapeutic range was reported in 80% of patients. Regarding patient satisfaction, 90% of the total population was satisfied by the new experience.
Conclusion: Decentralization and virtualization of the INR clinic have similar TTR results if conducted properly.
Graphical Abstract
[1]
Topcuoglu, N. Public health emergency of international concern: Coronavirus disease 2019 (COVID-19). Open Dent. J., 2020, 14(1), 71-72.
[http://dx.doi.org/10.2174/1874210602014010071]
[http://dx.doi.org/10.2174/1874210602014010071]
[2]
Zhang, G. The impact of the COVID-19 outbreak on the medical treatment of Chinese children with Chronic Kidney Disease (CKDD): A multicenter cross-section study in the context of a public health emergency of international concern. medRxiv, 2020.
[3]
Chan, J.F.W.; Yuan, S.; Kok, K.H.; To, K.K.W.; Chu, H.; Yang, J.; Xing, F.; Liu, J.; Yip, C.C.Y.; Poon, R.W.S.; Tsoi, H.W.; Lo, S.K.F.; Chan, K.H.; Poon, V.K.M.; Chan, W.M.; Ip, J.D.; Cai, J.P.; Cheng, V.C.C.; Chen, H.; Hui, C.K.M.; Yuen, K.Y. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet, 2020, 395(10223), 514-523.
[http://dx.doi.org/10.1016/S0140-6736(20)30154-9] [PMID: 31986261]
[http://dx.doi.org/10.1016/S0140-6736(20)30154-9] [PMID: 31986261]
[4]
Srinivasa Rao, A.S.R.; Vazquez, J.A. Identification of COVID-19 can be quicker through artificial intelligence framework using a mobile phone–based survey when cities and towns are under quarantine. Infect. Control Hosp. Epidemiol., 2020, 41(7), 826-830.
[http://dx.doi.org/10.1017/ice.2020.61] [PMID: 32122430]
[http://dx.doi.org/10.1017/ice.2020.61] [PMID: 32122430]
[5]
Gates, B. Responding to Covid-19 — A once-in-a-century pandemic? N. Engl. J. Med., 2020, 382(18), 1677-1679.
[http://dx.doi.org/10.1056/NEJMp2003762] [PMID: 32109012]
[http://dx.doi.org/10.1056/NEJMp2003762] [PMID: 32109012]
[6]
Bashshur, R.; Doarn, C.R.; Frenk, J.M.; Kvedar, J.C.; Woolliscroft, J.O. Telemedicine and the COVID-19 Pandemic, Lessons for the Future. Telemed. J. E Health, 2020, 26(5), 571-573.
[http://dx.doi.org/10.1089/tmj.2020.29040.rb] [PMID: 32275485]
[http://dx.doi.org/10.1089/tmj.2020.29040.rb] [PMID: 32275485]
[7]
Smith, A.C.; Thomas, E.; Snoswell, C.L.; Haydon, H.; Mehrotra, A.; Clemensen, J.; Caffery, L.J. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J. Telemed. Telecare, 2020, 26(5), 309-313.
[http://dx.doi.org/10.1177/1357633X20916567] [PMID: 32196391]
[http://dx.doi.org/10.1177/1357633X20916567] [PMID: 32196391]
[8]
Rosendaal, F.R.; Cannegieter, S.C.; van der Meer, F.J.M.; Briët, E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb. Haemost., 1993, 69(3), 236-239.
[http://dx.doi.org/10.1055/s-0038-1651587] [PMID: 8470047]
[http://dx.doi.org/10.1055/s-0038-1651587] [PMID: 8470047]
[9]
Bungard, T. Anticoagulation clinics in North America: operational insights. Can. J. Hosp. Pharm., 2008, 61(4)
[10]
Chiquette, E.; Amato, M.G.; Bussey, H.I. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch. Intern. Med., 1998, 158(15), 1641-1647.
[http://dx.doi.org/10.1001/archinte.158.15.1641] [PMID: 9701098]
[http://dx.doi.org/10.1001/archinte.158.15.1641] [PMID: 9701098]
[11]
Chamberlain, M.A.; Sageser, N.A.; Ruiz, D. Comparison of anticoagulation clinic patient outcomes with outcomes from traditional care in a family medicine clinic. J. Am. Board Fam. Pract., 2001, 14(1), 16-21.
[PMID: 11206689]
[PMID: 11206689]
[12]
Rudd, K.M.; Dier, J.G. Comparison of two different models of anticoagulation management services with usual medical care. Pharmacotherapy, 2010, 30(4), 330-338.
[http://dx.doi.org/10.1592/phco.30.4.330] [PMID: 20334453]
[http://dx.doi.org/10.1592/phco.30.4.330] [PMID: 20334453]
[13]
Manzoor, B.S.; Cheng, W.H.; Lee, J.C.; Uppuluri, E.M.; Nutescu, E.A. Quality of pharmacist-managed anticoagulation therapy in long-term ambulatory settings: A systematic review. Ann. Pharmacother., 2017, 51(12), 1122-1137.
[http://dx.doi.org/10.1177/1060028017721241] [PMID: 28735551]
[http://dx.doi.org/10.1177/1060028017721241] [PMID: 28735551]
[14]
Kaatz, S. Determinants and measures of quality in oral anticoagulation therapy. J. Thromb. Thrombolysis, 2008, 25(1), 61-66.
[http://dx.doi.org/10.1007/s11239-007-0106-9] [PMID: 17906916]
[http://dx.doi.org/10.1007/s11239-007-0106-9] [PMID: 17906916]
[15]
Schulman, S.; Kearon, C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patients. J. Thromb. Haemost., 2005, 3(4), 692-694.
[http://dx.doi.org/10.1111/j.1538-7836.2005.01204.x] [PMID: 15842354]
[http://dx.doi.org/10.1111/j.1538-7836.2005.01204.x] [PMID: 15842354]
[16]
Kaatz, S.; Ahmad, D.; Spyropoulos, A.C.; Schulman, S. Definition of clinically relevant non‐major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non‐surgical patients: communication from the SSC of the ISTH. J. Thromb. Haemost., 2015, 13(11), 2119-2126.
[http://dx.doi.org/10.1111/jth.13140] [PMID: 26764429]
[http://dx.doi.org/10.1111/jth.13140] [PMID: 26764429]
[17]
Alhmoud, E.N.; Abd El Samad, O.B.; Elewa, H.; Alkhozondar, O.; Soaly, E.; El Anany, R. Drive‐up INR testing and phone‐based consultations service during COVID ‐19 pandemic in a pharmacist‐lead anticoagulation clinic in Qatar: Monitoring, clinical, resource utilization, and patient‐ oriented outcomes. J. Am. Coll. Clin. Pharm., 2021, 4(9), 1117-1125.
[http://dx.doi.org/10.1002/jac5.1469] [PMID: 34226887]
[http://dx.doi.org/10.1002/jac5.1469] [PMID: 34226887]
[18]
Wittkowsky, A.K.; Nutescu, E.A.; Blackburn, J.; Mullins, J.; Hardman, J.; Mitchell, J.; Vats, V. Outcomes of oral anticoagulant therapy managed by telephone vs in-office visits in an anticoagulation clinic setting. Chest, 2006, 130(5), 1385-1389.
[http://dx.doi.org/10.1378/chest.130.5.1385] [PMID: 17099014]
[http://dx.doi.org/10.1378/chest.130.5.1385] [PMID: 17099014]
[19]
Al Ammari, M.; AlThiab, K.; AlJohani, M.; Sultana, K.; Maklhafi, N.; AlOnazi, H.; Maringa, A. Tele-pharmacy anticoagulation clinic during COVID-19 pandemic: Patient outcomes. Front. Pharmacol., 2021, 12, 652482.
[http://dx.doi.org/10.3389/fphar.2021.652482] [PMID: 34566632]
[http://dx.doi.org/10.3389/fphar.2021.652482] [PMID: 34566632]
[20]
Stoudenmire, L.G.; DeRemer, C.E.; Elewa, H. Telephone versus office-based management of warfarin: impact on international normalized ratios and outcomes. Int. J. Hematol., 2014, 100(2), 119-124.
[http://dx.doi.org/10.1007/s12185-014-1619-6] [PMID: 24952031]
[http://dx.doi.org/10.1007/s12185-014-1619-6] [PMID: 24952031]
[21]
Witt, D.M.; Sadler, M.A.; Shanahan, R.L.; Mazzoli, G.; Tillman, D.J. Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest, 2005, 127(5), 1515-1522.
[http://dx.doi.org/10.1378/chest.127.5.1515] [PMID: 15888822]
[http://dx.doi.org/10.1378/chest.127.5.1515] [PMID: 15888822]
[22]
Almeman, A.A.; Rasool, S. Impact of computer-aided warfarin dosing in a Saudi Arabian cardiac centre. Trop. J. Pharm. Res., 2014, 12(6), 1065-1070.
[http://dx.doi.org/10.4314/tjpr.v12i6.30]
[http://dx.doi.org/10.4314/tjpr.v12i6.30]
[23]
Alyousif, S.M.; Alsaileek, A.A. Quality of anticoagulation control among patients with atrial fibrillation: An experience of a tertiary care center in Saudi Arabia. J. Saudi Heart Assoc., 2016, 28(4), 239-243.
[http://dx.doi.org/10.1016/j.jsha.2016.02.001] [PMID: 27688671]
[http://dx.doi.org/10.1016/j.jsha.2016.02.001] [PMID: 27688671]
[24]
Caldeira, D.; Cruz, I.; Morgado, G.; Stuart, B.; Gomes, C.; Martins, C.; João, I.; Pereira, H. Evaluation of time in therapeutic range in anticoagulated patients: a single-center, retrospective, observational study. BMC Res. Notes, 2014, 7(1), 891.
[http://dx.doi.org/10.1186/1756-0500-7-891] [PMID: 25491419]
[http://dx.doi.org/10.1186/1756-0500-7-891] [PMID: 25491419]
[25]
Bernstein, M.R.; John, L.; Sciortino, S.; Arambages, E.; Auletta, D.; Spyropoulos, A.C. Does telehealth improve anticoagulation management in patient service centers (PSC)? A pilot project. J. Thromb. Thrombolysis, 2020, 49(2), 316-320.
[http://dx.doi.org/10.1007/s11239-019-02031-4] [PMID: 31898275]
[http://dx.doi.org/10.1007/s11239-019-02031-4] [PMID: 31898275]
[26]
Zobeck, B.; Carson, E.; MacDowell, M.; Hunt, A.; Reeder, A. Appointment attendance and patient perception of drive‐up INR testing in a rural anticoagulation clinic during the COVID‐19 pandemic. J. Am. Coll. Clin. Pharm., 2021, 4(4), 459-464.
[http://dx.doi.org/10.1002/jac5.1390] [PMID: 33821238]
[http://dx.doi.org/10.1002/jac5.1390] [PMID: 33821238]
[27]
Waterman, A.D.; Banet, G.; Milligan, P.E.; Frazier, A.; Verzino, E.; Walton, B.; Gage, B.F. Patient and physician satisfaction with a telephone-based anticoagulation service. J. Gen. Intern. Med., 2001, 16(7), 460-463.
[http://dx.doi.org/10.1046/j.1525-1497.2001.016007460.x] [PMID: 11520383]
[http://dx.doi.org/10.1046/j.1525-1497.2001.016007460.x] [PMID: 11520383]
