Clinical Outcomes of Telemonitoring for Patients on Warfarin after Discharge from Hospital

Abstract

Objective To evaluate the impact of telephone follow-up service on clinical outcomes in patients on warfarin when discharged from hospital. Methods This randomized controlled trial was conducted at a general hospital in Thailand. Patients aged ≥20 years who were prescribed warfarin when discharged were eligible to participate in this study. They were randomly allocated, using a computer generated random number, to receive either telephone follow-up intervention or usual care. Participants in the intervention group received telephone follow-up by hospital pharmacists for three months. During each telephone call, pharmacists performed medicine use reviews and addressed any problems identified. Key Findings A total of 50 patients participated in this study. The proportion of international normalized ratio (INR) values in the target range for the telephone follow-up group (36/79, 45.6%) was higher than that in the usual care group (19/79, 24.1%), p=0.005. The mean time in the therapeutic range (TTR) in the telephone follow-up group was also higher than that in the usual care group (49.8±34.3 versus 28.0±27.5, p=0.017). All patients in the usual care group experienced one or more out-of-range INR values (25/25, 100%) compared to 21 out of 25 (84%) in the telephone follow-up group, p=0.037. There was no difference between the two groups in the incidence of complications or adverse events associated with warfarin. Conclusions The telephone follow-up service in recently discharged patients helps them achieve and maintain their INR target. This anticoagulant supportive service should be promoted to patients receiving warfarin therapy after discharge. This trial is registered with TCTR20180614006 (Thai Clinical Trials Registry).

Technology-Based Interventions in Oral Anticoagulation Management: Meta-Analysis of Randomized Controlled Trials

“…After removing duplicate studies, 2 authors independently reviewed and excluded another 5652 studies that did not meet predetermined selection criteria, based on the title and abstract of each paper. After reading 33 eligible full-text studies, 18 were excluded and 15 were selected for inclusion in the analysis [ 12 , 19 - 31 ]. The systematic search results are shown in Figure 1 .…”

Optimising health outcomes via pharmacist delivered telehealth medicines management: a systematic review

“…There were 11 studies that met our inclusion criteria with a total of 7732 participants of which five were reported across multiple papers (Figure 1). 14–35 The participants included 3372 females and 4360 males with a weighted mean (SD) age of 60.9 (4.2) years; follow up ranged from 3 to 54 months. Just over half the studies were set in the United States of America, with studies set in one each of the United Kingdom, Thailand, Jordan and Iran (Table 1).…”

“…25 Only one study reported clinically significant adverse events. 33 It reported an equivalent number of participants in both groups who experienced bleeding events and thrombotic events (e.g. cerebrovascular events, pulmonary embolism or myocardial infarction).…”

“…An initial face-to-face consultation was a component of almost half the studies. 22,25,29,33 Most interventions included at least one adjuvant such as home monitoring, web-based portals, text message and written materials ( Table 1). Of the pharmacist interventions, pharmacists in three studies had prescriptive authority to adjust and change medicines 16,25,34 and pharmacists in three studies could order laboratory results.…”

“…20 The other three studies defined usual care as standard pharmacist counselling on discharge, nurse-led telehealth and care provided at an outpatient nurse-physician run diabetes clinic. 22,33,34…”