Improving anticoagulation therapy using point-of-care testing and a standardized protocol

Area of Science:

• Primary Care Medicine
• Pharmacology
• Quality Improvement in Healthcare

Background:

• Warfarin anticoagulation is crucial for preventing thromboembolism in primary care.
• Maintaining a therapeutic international normalized ratio (INR) with warfarin is complex and challenging.
• Effective anticoagulation management is essential for patient safety and treatment efficacy.

Purpose of the Study:

• To enhance the proportion of patients on warfarin therapy with INR values within the desired therapeutic range.
• To evaluate the impact of point-of-care (POC) testing and a standardized dosing protocol on warfarin management.
• To improve the quality of anticoagulation services in a family medicine residency practice.

Main Methods:

• A quality improvement initiative was conducted in a family medicine residency practice.
• Data were collected during three periods: baseline, POC testing implementation, and standardized protocol implementation.
• INR monitoring frequency and percentage of INR values within goal range were key outcome measures.

Main Results:

• Point-of-care (POC) testing increased INR monitoring frequency (2.6 to 4.3 tests/patient) but did not significantly improve INR control (30.8% to 32.1%).
• Implementing a standardized warfarin dosing protocol, alongside POC testing, significantly increased the percentage of patients within the goal INR range (32.1% to 45.9%).
• The standardized protocol demonstrated a statistically significant improvement in therapeutic INR control (P<.04).

Conclusions:

• Point-of-care (POC) testing enhances INR monitoring frequency.
• A standardized warfarin dosing protocol is critical for improving therapeutic INR control in primary care.
• This anticoagulation management model is readily adaptable for implementation in various family medicine settings.