Optimizing Warfarin Therapy in a Rural Hospital Through the Use of a Diagnostic Management Team.
BACKGROUND: Warfarin is indicated for the prevention and treatment of venous thrombosis and thromboembolic complications associated with atrial fibrillation. The delivery of high-quality healthcare in a rural hospital requires the same, if not higher, focus on managing patients' international normal...
| Published in: | Clinical Laboratory Science Vol. 36; no. 1; pp. 10 - 20 |
|---|---|
| Main Authors: | , , , |
| Format: | algorithm pictorial research tables/charts Journal Article |
| Published: |
American Society for Clinical Laboratory Science
Winter2023
|
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=190956601&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 190956601 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0894959X IKL jtl: Clinical Laboratory Science issn: 0894959X maglogo: N pubinfo: dt: Winter2023 vid: 36 iid: 1 pid: 13703 pub: American Society for Clinical Laboratory Science place: Dundee, Michigan artinfo: ui: 190956601 190956601 190956601 190956601 ppf: 10 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Optimizing Warfarin Therapy in a Rural Hospital Through the Use of a Diagnostic Management Team. aug: au: SALAZAR, EDDIE ZAHNER, CHRISTOPHER LEE, JAMES RANDALL KOIRALA, SANAM affil: University of Texas Medical Branch sug: subj: Hospitals, Rural Warfarin Administration and Dosage Medication Management Methods Laboratory Personnel Health Care Delivery, Integrated Outcomes (Health Care) Evaluation Human Texas Male Female Adult Middle Age Aged Aged, 80 and Over Retrospective Design Record Review Quasi-Experimental Studies Warfarin Blood International Normalized Ratio Venous Thrombosis Prevention and Control Hemorrhage Prevention and Control Pulmonary Embolism Prevention and Control Prothrombin Time Descriptive Statistics Data Analysis Software Paired T-Tests Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: BACKGROUND: Warfarin is indicated for the prevention and treatment of venous thrombosis and thromboembolic complications associated with atrial fibrillation. The delivery of high-quality healthcare in a rural hospital requires the same, if not higher, focus on managing patients' international normalized ratio (INR) within the therapeutic range. Options for warfarin management include anticoagulation clinics, in-home self-testing, pharmacist-led management, and physician-led management. However, rural hospitals are usually unable to afford specialized anticoagulation clinics to monitor patients receiving warfarin therapy. The purpose of this study is to optimize and examine the efficacy of warfarin therapy management in a rural hospital by utilizing the resources available within the hospital through the use of a diagnostic management team (DMT). DESIGN: In order to evaluate the efficacy of DMT for warfarin management in a rural hospital (Hamilton General Hospital, Hamilton, TX), we conducted a retrospective chart review to analyze the time in therapeutic range (TTR) for the target and expanded therapeutic ranges (±0.2 and ±0.3 INR units), average percentage of INR values in the target and expanded therapeutic ranges, and percentage of INR <1.5 and INR >4.5. These outcomes were compared before and after DMT implementation. RESULTS: A total of 50 patients (48% male and 52% female) underwent 205 INR measurements before DMT implementation and 247 INR measurements after DMT. The most common indication for warfarin was atrial fibrillation, followed by DVT. TTR for the target range increased from 52% pre-DMT to 64% post-DMT. TTR for the expanded therapeutic range (±0.2 INR units) increased from 64% pre-DMT to 77% post-DMT. Similarly, TTR for the expanded therapeutic range (±0.3 INR units) increased from 69% pre-DMT to 81% post-DMT. The average percentage of therapeutic INRs was 62% pre-DMT and 74% post-DMT (P < .05) for the target range, 72% pre- DMT and 86% post-DMT (P < .05) for the expanded therapeutic range (±0.2 INR units), and 76% pre-DMT and 86% post-DMT (P < .05) for the expanded therapeutic range (±0.3 INR units). The percentage of INR <1.5 decreased by 6.9% and INR >4.5 decreased by 1.6% post-DMT. CONCLUSION: Incorporating a comprehensive approach for optimizing warfarin therapy through the use of DMT and utilizing the resources available in a rural hospital improved TTR and the percentage of INRs in the therapeutic range for both target and expanded therapeutic ranges and decreased bleeding and clotting episodes as well as warfarin-related documentation. DMT may be an economically attractive alternative platform to prevent bleeding and clotting and improve treatment monitoring for patients on warfarin therapy. pubtype: Academic Journal doctype: algorithm pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|