Thompson Amy N, Ragucci Kelly R, Fermo Joli D, Whitley Heather P
Primary Care with Emphasis in Family Medicine Resident. Medical University of South Carolina . Charleston, SC ( United States ).
Associate Professor, Pharmacy and Clinical Sciences/Family Medicine. South Carolina College of Pharmacy, Medical University of South Carolina Campus . Charleston, SC ( United States ).
Pharm Pract (Granada). 2009 Oct;7(4):213-7. doi: 10.4321/s1886-36552009000400004. Epub 2009 Mar 15.
Until recently, Prothrombin Time/International Normalized Ratio (PT/INR) measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT) device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory.
To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed anticoagulation clinic using point-of-care testing (POCT) device versus venipuncture within ambulatory care clinics at our institution.
All patients currently treated with warfarin therapy who were managed by clinical pharmacists for anticoagulation monitoring at the Medical University of South Carolina (MUSC) Family Medicine Center and University Diagnostic Center, were enrolled. Patients were asked to complete a satisfaction survey regarding their anticoagulation monitoring. In addition, data related to emergency department (ED) visits, hospitalizations and percent of time in the INR therapeutic range for 6 months pre- and post-implementation of POCT device was collected. This information was obtained through an electronic patient information database, Oacis.
A total of 145 patients were included in the data collection from the two clinics. The majority (41%) of these patients were taking warfarin for atrial fibrillation. Satisfaction surveys were completed by 86 (59 %) of patients. The surveys revealed that POCT device was preferred over venipuncture in 95% of patients. Reasons for the preference included more face-to-face interaction, less wait time, less pain, less blood needed, and quicker results. Of the 145 patients who were included in the objective data analysis, no significant differences were found in the number of hospitalizations, ED visits, or percent of time in the INR therapeutic range pre- and post-implementation of POCT device.
The results of this study demonstrate improvement in patient satisfaction with POCT compared to venipuncture, with limited value in clinical outcomes.
直到最近，凝血酶原时间/国际标准化比值（PT/INR）测量通常通过机构实验室经静脉穿刺来监测服用华法林的患者。即时检验（POCT）设备通过允许在中心实验室之外进行实验室检测，彻底改变了患者护理流程。
分析目前接受华法林治疗并通过药剂师管理的抗凝门诊使用即时检验（POCT）设备进行监测的患者，与在我们机构的门诊护理诊所通过静脉穿刺进行监测的患者相比，其人文和临床结局。
纳入所有目前接受华法林治疗且由南卡罗来纳医科大学（MUSC）家庭医学中心和大学诊断中心的临床药剂师进行抗凝监测的患者。要求患者完成一份关于其抗凝监测的满意度调查。此外，收集与即时检验（POCT）设备实施前后6个月内的急诊科就诊、住院情况以及INR处于治疗范围内的时间百分比相关的数据。这些信息通过电子患者信息数据库Oacis获取。
来自两个诊所的数据收集共纳入了145例患者。这些患者中大多数（41%）因心房颤动服用华法林。86例（59%）患者完成了满意度调查。调查显示，95%的患者更喜欢即时检验（POCT）设备而非静脉穿刺。偏好的原因包括更多的面对面互动、等待时间更短、疼痛更少、所需血量更少以及结果更快。在纳入客观数据分析的145例患者中，即时检验（POCT）设备实施前后在住院次数、急诊科就诊次数或INR处于治疗范围内时间的百分比方面未发现显著差异。
本研究结果表明，与静脉穿刺相比，即时检验（POCT）提高了患者满意度，但在临床结局方面价值有限。
