Tele-pharmacy Anticoagulation Clinic During COVID-19 Pandemic: Patient Outcomes.

Maha Al Ammari,Khizra Sultana,Manal Aljohani,Aswaq Maringa,Khalefa Althiab,Nada Maklhafi,Hayel Alonazi

doi:10.3389/fphar.2021.652482

Abstract

Introduction: It is well-established that clinical pharmacist-managed anticoagulation services achieve superior anticoagulation control, with a positive impact. At King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, the structure of anticoagulation management is a pharmacist-managed specialty service. With the current COVID-19 situation, measures were taken to assure the continuity of patient care by establishing tele-pharmacy anticoagulation clinics.Materials and Methods: This was a prospective study with patients prescribed anticoagulation and followed up for 3 months. Since establishing the anticoagulation virtual clinic in March 2020, 270 patients were recruited in the study. The data collected included age, gender, comorbidities, indication for anticoagulation, intended duration of treatment, warfarin dose, testing of International Normalized Ratio (INR), INR target, range of INR values, time INR that was within the therapeutic range (TTR), and complications of therapy (bleeding and/or bruises). The patients were asked to complete the pharmacist satisfaction survey (PSS) after their consultation to assess patient satisfaction with the new virtual consultation system. Linguistic and cultural validation was conducted for the questionnaire.Results: A total of 270 patients were included in the study. The mean percentage of overall INR values in the range was 59.39% ± 32.84, and the mean time with the overall INR was within the therapeutic range 57.81% ± 32.08. Thirty-one percent of the sample had good anticoagulation control (time in therapeutic range >70%). The median satisfaction score was 32 (IQR 28–36) with a maximum score of 40.Conclusion: This is the first study to assess the tele-pharmacy anticoagulation clinic’s efficiency and patient satisfaction in Saudi Arabia during the COVID-19 pandemic. This type of consultation was as effective as face-to-face consultations. The study also highlighted that though the reduction in the cost of care was not substantial, there was a significant increase in resource (clinical pharmacist) utilization as a result of this model. The adoption of tele-pharmacy resulted in time savings for the clinical pharmacists who can be utilized in many other improvement projects in adult ambulatory clinics to ensure the delivery of better quality and safe patient care.

Highlights

It is well-established that clinical pharmacist-managed anticoagulation services achieve superior anticoagulation control, with a positive impact
Anticoagulation control was defined good if the meantime therapeutic range was above 70%, intermediate if the meantime in therapeutic range was between 50 and 70%, and inadequate if the meantime in therapeutic range was below 50% (Rosendaal et al, 1993)
We found a significant difference in the mean therapeutic International Normalized Ratio (INR), based on the duration of the anticoagulation, ≤6 wk or >6 wk

Summary

Introduction

It is well-established that clinical pharmacist-managed anticoagulation services achieve superior anticoagulation control, with a positive impact. In primary care settings and hospital-based anticoagulation clinics, computerized decision-support applications or other means to guide the warfarin dosing may be used These services provide a systematic and focused approach to improve the quality, safety, and efficacy of delivering anticoagulation care (Bungard et al, 2008). Clinical pharmacist-managed anticoagulation services achieve superior anticoagulation control and have a positive impact It reduces the rate of hospitalization and emergency department visits due to anticoagulation therapy-related adverse events, resulting in a significant cost-saving in long-term outpatient follow-up (Chiquette et al, 1998; Chamberlain et al, 2001; Rudd and Dier 2010; Manzoor et al, 2017). Anticoagulation control was defined as good if the mean time of the therapeutic range (TTR) was above 70%, intermediate between 50 and 70%, and inadequate below 50% (Rosendaal et al, 1993)

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Results

Discussion

Conclusion