Division of Internal Medicine; Staten Island University Hospital, Staten Island, NY, USA.
Division of Hematology/Oncology; Staten Island University Hospital, Staten Island, NY, USA.
Int J Gen Med. 2013 Dec 3;6:869-75. doi: 10.2147/IJGM.S50057. eCollection 2013.
Anticoagulation management is currently performed through anticoagulation clinics or self-managed with or without the help of medical services. Homebound patients are a unique population that cannot utilize anticoagulation clinics or self-testing. Telephone-based anticoagulation management could be an alternative to the traditional methods of monitoring warfarin in this subgroup. The objective of this retrospective, observational study is to investigate the feasibility of warfarin management in homebound patients.
This study was performed through the use of telephone-based adjustments of warfarin dose based on an international normalized ratio (INR) result. Four hundred forty-eight homebound patients referred to the anticoagulation clinic at Staten Island University Hospital were visited at home by a phlebotomist; a blood sample was drawn for initial laboratory testing. A nurse practitioner then called the patient or designated person to relay the INR result and to direct dosage adjustment. INR results and dosage changes were entered into an electronic medical record and analyzed statistically.
The mean percentage of INR values in range was 58.39%. The mean time when the INR was in the therapeutic range was 62.75%. The percent of patients who were therapeutically controlled decreased as the number of medications increased. The complication rate was 4% per patient year, with an equal distribution between bleeding and clotting. These values compared favorably to other studies in which monitoring was performed through anticoagulation clinics or self-monitoring. The cost per visit at our anticoagulation clinic was found to be approximately $300 compared with $82 when utilizing our homebound service.
Telephone-based management of warfarin therapy in the homebound setting is feasible. It can lower the cost of health care expenditures compared to other modalities of anticoagulation management.
抗凝管理目前通过抗凝诊所进行，或者在医疗服务的帮助下进行自我管理。行动不便的患者是一个特殊群体，他们无法使用抗凝诊所或自我检测。基于电话的抗凝管理可能是替代传统监测华法林方法的替代方案。本回顾性观察研究的目的是调查在行动不便患者中进行华法林管理的可行性。
本研究通过使用电话根据国际标准化比值（INR）结果调整华法林剂量来进行。 448 名被转诊到史坦顿岛大学医院抗凝诊所的行动不便患者由一名采血员上门进行采血以进行初始实验室检测。然后，执业护士会打电话给患者或指定人员，告知 INR 结果并指导剂量调整。 INR 结果和剂量变化被输入电子病历并进行统计学分析。
INR 值在范围内的平均值为 58.39%。 INR 值处于治疗范围内的平均值为 62.75%。随着药物数量的增加，治疗控制的患者比例下降。每个患者每年的并发症发生率为 4%，出血和血栓形成的发生率相等。与通过抗凝诊所或自我监测进行监测的其他研究相比，这些值表现良好。我们的抗凝诊所每次就诊的费用约为 300 美元，而利用我们的居家服务则为 82 美元。
在居家环境下通过电话进行华法林治疗管理是可行的。与其他抗凝管理方式相比，它可以降低医疗保健支出的成本。
