Evaluation of a Pharmacist-Led Remote Warfarin Management Model Using a Smartphone Application (Yixing) in Improving Patients' Knowledge and Outcomes of Anticoagulation Therapy.

Shudan Jiang,Qiuyi He,Pan Chen,Xiao Chen,Yifan Zheng,Liyan Zhao,Jiajia Yan

doi:10.3389/fphar.2021.677943

Abstract

Background: The management of warfarin-treated patients has been recognized as a challenge due to narrow therapeutic range and food and drug interactions in warfarin therapy. We aim to evaluate the effect of a pharmacist-led remote warfarin management model using a smartphone application (app) on anticoagulation therapy. Methods: Eligible patients who had received warfarin therapy after mechanical heart valve replacement were enrolled. The intervention group was offered a pharmacist-led remote warfarin management model using the app named Yixing. Yixing incorporates functions including automatic daily reminder, personal health record, educational program, and online counseling. The control group received traditional pharmacy services without Yixing. Co-primary outcomes were patients’ awareness score of warfarin therapy obtained from questionnaire, the medication adherence measured by the percentage of the correct-warfarin-taken days in the monitored period, the fraction of time in therapeutic range (FTTR), and the incidence of anticoagulation-related complications. The needed information of the patients was acquired via electronic medical records from the hospital, Yixing system and telephone follow-up when necessary. Results: 64 and 66 patients were initially in the intervention and control groups respectively. After propensity score matching, 50 patients were assigned in each group. The intervention group had a median age of 51.0 years, in which 27 (54%) were male. The control group had a median age of 50.5 years, in which 28 (56%) were male. Patient awareness score in the intervention group was 8.00 (2.00), which was higher than that in the control group, with score at 6.50 (2.50) (p = 0.001). No significant difference was found in the percentage of the correct-warfarin-taken days between the two groups (p = 0.520). The median (interquartile range) value of FTTR was 80.3% (21.9%) and 72.1% (17.7%) in the intervention and control groups respectively (p = 0.033), and no significant differences in the incidence of anticoagulation-related complications were observed (p = 0.514). Conclusion: The pharmacist-led remote warfarin management model using Yixing improves patients’ awareness of warfarin therapy and increases FTTR, but may not have significant improvements on medication adherence and safety.

Highlights

Anticoagulation therapy plays a crucial role in the prevention and treatment of diseases such as venous thromboembolism, atrial fibrillation, and valvular heart disease
After PSM, 50 patients were in the intervention group and had a median age of 51.0 years, in which 27 (54%) were male and a corresponding 50 patients were in the control group and the median age was 50.5 years, in which 28 (56%) were male
No significant difference was found in the percentage of the correct-warfarin-taken days between the two groups (p 0.520). 72% of patients in the intervention group and 78% of patients in the control group had 100% correct-warfarin-taken days (Table 3)

Summary

Introduction

Anticoagulation therapy plays a crucial role in the prevention and treatment of diseases such as venous thromboembolism, atrial fibrillation, and valvular heart disease. In comparison to the remote management using telephone follow-ups, public social platforms and remote electronic service systems, management using smartphone application (app) has drawn great interest in recent years, due to their functions in timely recording warfarin dose and INR value, and return of individualized medication recommendation (Winkle et al, 2014). Most of those apps were operated commercially without enough participation of medical staffs, and the reported medical staffs responsible for follow-up management were normally physicians and nurses, focusing on the controls of diseases progress and medication adherence. We aim to evaluate the effect of a pharmacist-led remote warfarin management model using a smartphone application (app) on anticoagulation therapy

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Conclusion