Abstract
Few studies have explored the impact of transportation to pharmacies on outcomes in patients receiving anticoagulation therapy. Our aim is to explore the relationship between patient’s travel distance and time to their dispensing pharmacy on the quality of warfarin control in an underserved urban population. English-speaking adults receiving long-term warfarin therapy from an ambulatory Anti-Thrombosis Clinic completed an interview-administered questionnaire. Patients’ residential address and pharmacy locations were geocoded using SAS 9.4 GEOCODE procedure. Geodetic distance was calculated between residence and pharmacy. Three-months of International Normalized Ratio (INR) was abstracted from the medical records to calculate time in therapeutic range (TTR) using the Rosendaal method. Acceptable control was defined as TTR ≥60%. Impact of travel distance or time to pharmacy on warfarin control was assessed using logistic regression. Patients who did not pick up their own medication or had missing INR data were excluded from logistic regression analysis. Of 144 recruited patients, mean (SD) age was 60 years (13.7), 102 (70.8%) African-American, 43 (29.9%) had income <$15,000, and 51 (35.4%) were disabled/unable to work. Twenty patients (13.9%) reported some trouble getting to their pharmacy. Most patients drove themselves (30.1%) or were driven by someone (26.6%). Of 104 patients, mean (SD) travel distance was 2.96 miles (3.81) and travel time was 22.2 minutes (20.3). Mean (SD) TTR was 61% (31%). Sixty-four (48.1%) patients had poor control. There was no significant association between anticoagulation control and travel distance or time. In this small sample of underserved urban patients, travel distance and time to pharmacy were not associated with warfarin control. However, some patients reported having trouble getting to their pharmacy. Transportation is only one of several factors that can affect warfarin control.
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