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Implementation of a Telemedicine Direct Oral Anticoagulant Monitoring Program at a Safety-Net Hospital
Stacey Cohen Kaplon1, Sumaia Aqtash1, David Gilbride2
1Boston Medical Center, Boston, MA, USA.
Insights
Pharmacists successfully implemented a telemedicine service for monitoring direct oral anticoagulants (DOACs), leading to significant interventions. This approach improves patient safety and outcomes for those on DOAC therapy.
Area of Science:
- Pharmacology
- Health Services Research
- Telemedicine
Background:
- Direct oral anticoagulants (DOACs) are standard for nonvalvular atrial fibrillation and venous thromboembolism.
- Inadequate monitoring of DOACs can compromise patient outcomes and safety.
Purpose of the Study:
- To implement a standardized telemedicine monitoring service for patients on DOACs.
- To quantify pharmacist interventions within this service.
Main Methods:
- A 6-month project at a safety-net hospital.
- Integration of telemedicine appointments into the electronic health record.
- Development of standardized protocols and documentation tools for pharmacists.
Main Results:
- 164 encounters with 120 patients were analyzed.
- 92.7% of encounters involved at least one pharmacist intervention.
- The average number of interventions per patient was 2.0, with 37.2% of encounters having multiple interventions.
Conclusions:
- A standardized telemedicine monitoring service enables pharmacists to identify and manage DOAC-related issues.
- Pharmacist-led interventions and telemedicine follow-up are crucial for effective DOAC therapy management.
Abstract:
Purpose: Direct oral anticoagulants (DOACs) are the preferred choice of anticoagulation therapy for nonvalvular atrial fibrillation and venous thromboembolism. Inadequate monitoring of patients on DOACs may lead to suboptimal outcomes and safety concerns. This project aimed to implement a standardized telemedicine-based DOAC monitoring service and track pharmacist-based interventions. Methods: This project was conducted at a safety-net hospital over 6 months. Anticoagulation pharmacists developed a scheduling process for telemedicine DOAC follow-up appointments, integrated them into the electronic health record, and implemented standardized protocols and documentation tools. Outcomes of interest included the average number of pharmacist interventions per encounter and per patient. Results: One hundred sixty-four encounters involving 120 patients were included in the analysis. 92.7% of encounters resulted in at least 1 intervention, with 73.8% involving an education intervention. The average number of interventions per patient was 2.0, with 37.2% of encounters having multiple interventions. Conclusion: Implementation of a standardized telemedicine-based monitoring service allowed for pharmacist identification and management of issues related to DOAC therapy. These findings emphasize the importance of pharmacist-led interventions and telemedicine-based follow-up of DOAC therapy.
