Systematic management models such as anticoagulation clinics have emerged in order to optimize warfarin effectiveness and to minimize related complications. Most of these models are structured so that patients come to a clinic for in-person testing and evaluation, thus making this model of care difficult to access and time consuming for many patients. The emergence of portable instruments for measuring anticoagulant effect in capillary whole blood made it possible for patients receiving warfarin to self-monitor the effect of their anticoagulant therapy. Self-monitoring empowers patients, offers the advantage of more frequent monitoring, and increases patient convenience by allowing testing at home and avoiding the need for frequent laboratory and clinic visits. Self-monitoring can entail patient self-testing (PST) and/or patient self-management (PSM). Several studies have evaluated and shown the benefit of both PST and PSM models of care when compared with either routine medical care or anticoagulation clinic management of anticoagulation therapy. Self-monitoring (PSM and/or PST) of anticoagulation results in lower thromboembolic events, lower mortality, and no increase in major bleeding when compared with standard care. Despite favorable results and enhanced patient convenience, the adoption of self-monitoring into clinical practice in the United States has been limited, especially in higher risk, disadvantaged populations. Although the emergence of a multitude of novel oral anticoagulants will permit clinicians to better individualize anticoagulant therapy options by choosing the optimum regimen based on individual patient characteristics, it is also expected that traditional agents will continue to play a role in a significant subset of patients. For those patients treated with traditional anticoagulants such as warfarin, future models of care will entail patient-centered management such as PST and PSM. The incorporation of technology (i.e., Web-based expert systems) is expected to further improve the outcomes realized by PST and PSM. Further studies are needed to explore factors that influence the adoption of self-monitoring in the United States and to evaluate the feasibility and implementation in real-life clinical settings.

Most of the clinical track pharmacy faculty indicated that they have insufficient time to fulfill their nonclinical academic responsibilities. Provision of protected time may alleviate some of these time constraints.

A201the utilization of that services in Hungary. METHODS: Data were derived from the nationwide administrative dataset of the National Health Insurance Fund Administration (OEP), the only health care financing agency in Hungary. The utilization of home care (nursing) services was measured by the number of service provider, number of patients and the number of visits. We analzed the year 2011. RESULTS: The number of home care (nursing) service providers was 333. 80.8% of them was private for-profit, while 10.9% private nonprofit organization. Altogether 51,000 patients was visited by home care providers (50 patients/10,000 population). The total annual number of visits was 1,190,000 (1193 visits/10,000 population). The average health insurance reimbursement of 1 visit was 2788 Hungarian Forint (HUF) (10.0 EUR), while the average reim-bursement of 1 patient was 65,345 HUF (234.0 EUR). CONCLUSIONS: We found that only 0.5 % of the Hungarian population underwent home care (nursing) services in 2011. Further development of home care services should be encouraged in order to reduce unnecessary hospital care.

OBJECTIVES: Minority, underserved patients, such as African Americans and Hispanics, are at increased risk of anticoagulation related complications. Evidence shows that non-adherence has a negative influence on anticoagulation control. Therefore, the objective of the study was to identify patient factors affecting nonadherence with anticoagulation therapy in an inner-city, underserved minority population. METHODS: We conducted a cross-sectional survey of inner-city minority patients who received care at the University of Illinois at Chicago Antithrombosis Clinic. Data on socioeconomic and clinical characteristics, social support and factors associated with modes of transport to the clinic were collected by using survey questionnaires and reviewing medical records. Linear regression was performed to identify factors that could be potentially associated with non-adherence to anticoagulation therapy. RESULTS: A total of 243 African American (nϭ180) and Hispanic (nϭ63) patients participated in the survey. The mean age was 54.30 Ϯ 17.49. The majority of the patients were female (72.84%), had an education level of high school or less (60.44%), an annual income of Ͻ$15,000 (44.09%), and had Medicare or Medicaid as their primary insurance (77.37%). The mean time in therapeutic range (TTR) was 49.29 Ϯ 20.89% and mean non-adherence rate with anticoagulation therapy was 12.62 Ϯ 13.81%. Linear regression analysis showed that patients with missed appointments (pϽ0.01), and Medicare as primary insurance (pϭ0.03) were more likely to be non-adherent, whereas married patients (pϽ0.01) were less likely to be non-adherent. CONCLUSIONS: Our findings show that patients are more likely to be non-adherent with anticoagulation therapy when they miss their clinic appointments and have Medicare as their primary insurance. In addition, marriage as a form of social support decreases the likelihood non-adherence. Future research is needed on developing interventions that would target and reinforce adherence behaviors, help develop self-efficacy and motivation based on each patient's lifestyle and social support system.OBJECTIVES: According to current guidelines for the primary prevention of cardiovascular disease (CVD), early risk stratification might be critical to planning appro-A126

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