Drive-thru anticoagulation clinic: Can we supersize your care today?

Truong, Lynn; Whitfield, Kevin; Nickerson-Troy, Julia; Francoforte, Karen

doi:10.1016/j.japh.2020.10.016

Cited by 5 publications

(4 citation statements)

References 1 publication

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“…Thus, an anticoagulation drive-through approach to warfarin management can minimize potential exposure to the COVID-19 virus and can improve patient compliance with their anticoagulation care. 5 , 6 , 7 , 8 , 9 , 10 , 11 …”

Section: Discussionmentioning

confidence: 99%

“… Bookani KR et al 8 Multistep description on how authors’ drive-through clinic was implemented Three anticoagulation clinics with 2000 patients total, Illinois suburbs Pharmacy led Clinical outcomes and feasibility not published yet Large anticoagulation program covering 3 clinics Unknown if proposed model was feasible No patient outcomes or satisfaction measures Authors plan to study and publish feasibility and outcomes. Truong L et al 10 Commentary Description drive-through clinic Pharmacy led program Average age 67.5 years Able to sustain quality of anticoagulation as measured by %TTR 80 patients per week Able to sustain %TTR>80% Large weekly patient volume Able to sustain quality anticoagulation as measured by %TTR Improved patients’ satisfaction Able to sustain quality of anticoagulation Alhmoud E et al 11 Two-month report of 515 patients Al Wakra Hospital (Qatar) Pharmacy led >300 patients excluding pediatrics and pregnant females Provided another means to anticoagulation clinic access Patient no-show rates decreased from 56% pre-pandemic to 9.5% with drive-through care model No outcome measures such as quality of anticoagulation care as measured %TTR or % in therapeutic range Plan to use text messaging (e.g. WhatsApp and Viper) to improve communication with patients.…”

Section: Discussionmentioning

confidence: 99%

“… 3 , 4 , 5 , 6 , 7 Several groups have published the concept and experience of using a drive-through clinic for anticoagulation monitoring and management. 8 , 9 , 10 , 11 There are limited data on how this model of care can impact anticoagulation management as measured by quality of anticoagulation management (% INR in therapeutic range) and compliance. In response to the COVID-19 pandemic, our anticoagulation program implemented a drive-through anticoagulation clinic to provide the option for patients and families to stay in their vehicles while having a POC/INR performed.…”

Section: Introductionmentioning

confidence: 99%

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Drive-Through Anticoagulation Clinic During the COVID-19 Pandemic

Giver¹,

Dunn²,

Sankar³

et al. 2022

The Journal for Nurse Practitioners

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An innovative approach to anticoagulation management during the COVID-19 pandemic was used at our center that allowed patients to stay in their vehicle while our anticoagulation advanced practice nurse obtained blood for point-of-care INR (POC/INR) testing, while at the same time, education and counseling were completed. A significant improvement in the median percentage of INR within the therapeutic range (TR) was observed among the patients who utilized the drive-through clinic. A small group of patients improved compliance to anticoagulation monitoring. Clinical care models, such as this clinic approach may improve patient compliance and adherence to anticoagulation beyond the pandemic needs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Drive-Through Anticoagulation Clinic During the COVID-19 Pandemic

Giver¹,

Dunn²,

Sankar³

et al. 2022

The Journal for Nurse Practitioners

View full text Add to dashboard Cite

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“…Patients afraid of infection may be hesitant or refuse to come in for appointments and lab work even if considered essential. One way to help ease patient hesitation include testing options that do not require them to enter a hospital or clinic such as drive-up INR testing [22,23]. Another precaution is to ensure INR testing intervals are extended when clinically appropriate.…”

Section: Introductionmentioning

confidence: 99%

Extending INR testing intervals in warfarin patients at a multi-center anticoagulation clinic

Papala

Gillard

Hardman

et al. 2021

J Thromb Thrombolysis

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Warfarin has been used as an anticoagulant by millions of patients due to its effectiveness, availability, and low cost. Evidence on the safe extension of international normalized ratio (INR) testing frequency remains an area of interest, especially during the recent COVID-19 pandemic. The purpose of this study is to safely extend INR testing intervals in patients throughout a multisite, system-wide anticoagulation clinic. Updates were made to the pharmacist's collaborative practice agreement (CPA) and nurse protocol to optimize practice and allow INR testing interval extension up to a maximum of 8-weeks. The primary outcome was the change in duration between INR tests (INR testing interval) measured before and after providing staff education on clinic updates. The mean duration between INR tests (SD) was 23.69 days (11.29) in the pre-intervention period and 25.58 days (13.91) in the post-intervention period. During the COVID-19 pandemic (post2), intervals were extended further to 27.81 days (14.96), demonstrating a statistically significant increase in INR testing interval from pre-intervention to post-intervention and to post2 (p < 0.001 and p < 0.001, respectively). A secondary outcome indicated the mean time in therapeutic range (SD) showed no significant difference in pre-intervention 70.11% (25.95) versus post-intervention of 69.76% (25.69) with a difference of − 0.35% (29.93) (p = 0.956) or versus the post2 of 68.82% (27.20) with a difference of − 1.29% (33.20) (p = 0.120). This study showed that changes to the CPA and protocol allowed for a significant increase in INR testing interval while simultaneously maintaining a mean time in therapeutic range > 60% for the clinic population. KeywordsWarfarin • INR testing interval • Time in therapeutic range (TTR) • Protocol • Collaborative practice agreement • COVID-19 pandemic Highlights * Michelle Papala

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