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Benefits of a mobile, point-of-care anticoagulation therapy management program
1Christiana Care Health Services, 1401 Foulk Road, Wilmington, DE 19803, USA. jgill@christianacare.org
Insights
A mobile anticoagulation therapy management (ATM) program improved patient outcomes. The percentage of patients with in-range international normalized ratio (INR) levels increased significantly after program implementation, enhancing overall quality of care.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Anticoagulation therapy is crucial but carries bleeding risks.
- Maintaining therapeutic anticoagulation requires frequent international normalized ratio (INR) monitoring.
- Anticoagulation Therapy Management (ATM) clinics improve INR control and reduce complications.
Purpose of the Study:
- To evaluate the impact of a mobile, multisite, office-based ATM program.
- To assess changes in INR control and quality of care.
Main Methods:
- Retrospective cohort study design.
- Compared INR levels one year before and one year after ATM program implementation.
- Program involved a rotating nurse providing education, point-of-care INR testing, and medication adjustment.
Main Results:
- Percentage of in-range INRs increased from 40.7% to 58.5% (p < 0.001).
- Percentage in modified target INR range increased from 50.0% to 62.9% (p < 0.001).
Conclusions:
- A statewide office-based ATM program positively impacted patient care.
- Widespread implementation in specialty or primary care settings could significantly benefit anticoagulated patients.
Background:
Current guidelines recommend anticoagulation therapy for a number of medical conditions, but this therapy also has the potential for serious complications, particularly bleeding complications. Maintenance of anticoagulation within a narrow therapeutic window usually entails frequent monitoring with a blood test called the international normalized ratio (INR). Anticoagulation therapy management (ATM) clinics lead to improvements in quality of care, in terms of improved INR control and reduced complications. This study examined the impact of a mobile multisite, office-based ATM program that operated in seven cardiology offices in all three counties in Delaware. ATM PROGRAM: The ATM program was managed by a trained nurse who rotated among all seven offices. Patients made office visits to the nurse and received patient education, point-of-care INR testing, and medication adjustment based on a physician-approved algorithm.
Methods:
This retrospective cohort study compared INR levels in the year before (May 1998-Apr 1999) and the year after (Aug 1999-Jul 2000) the start of the ATM program.
Results:
From the year before to the year after implementation of the ATM program, the percentage of in-range INRs increased from 40.7% to 58.5% (p < 0.001). The percentage in the modified target range also increased (50.0% to 62.9%, p < 0.001).
Discussion:
This study demonstrates the positive impact of a statewide office-based ATM program. If similar programs could be implemented in other networks of specialty offices or primary care offices, they could have a significant benefit to quality of care for patients who require anticoagulation therapy.
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