A collaborative care model of anticoagulation therapy in patients with stroke
- Author:
Tzung-Yi Lee MS
;
Helen L Po
;
Ya-Ju Lin
;
Wen-Ju Tsun
;
Shen-Chuan Wang
- Publication Type:Journal Article
- From:Neurology Asia
2011;16(2):111-118
- CountryMalaysia
- Language:English
-
Abstract:
Background and Objectives: Anticoagulation clinics are widely used for anticoagulation management
in many countries, but have only recently began to gain acceptance in Taiwan. Our service model is
a physician-managed outpatient clinic collaborating with clinical pharmacist and nurse. This study
aimed to evaluate the adequacy of anticoagulation and rates of warfarin-related complications before
and after referral to our collaborative anticoagulation clinic (CAC). Methods: Stroke patients taking
warfarin from the neurology department were identifi ed and referred to the CAC during the 12-month
period from February 2009 to January 2010. Quality markers include percentage of international
normalized ratio (INR) values in the therapeutic range, frequency of INR monitoring, and frequency
of follow-up visits and the mean interval of next INR monitoring after non-therapeutic INRs were
compared one year before and after management in the CAC. Using studied patients as self-control,
they were included in the analysis if patients had at least 3 months follow-up or 3 INR values both
before and after referral. Results: A total of 44 stroke patients were included: mean age of 75.0 ± 9.7
years, with a CHADS2
score of 3.71 ± 0.69. The adequacy of anticoagulation was signifi cantly greater
during CAC care compared with the period before referral; the percentage of INR within expanded
therapeutic range was 60.9% versus 53.7%, respectively (p=0.049). Reduction in sub-therapeutic INR
values from 31.8% to 24.2% (p=0.023) contributed mostly to the improved quality of care. The time
interval of next INR monitoring after non-therapeutic INRs ( 4.0 or 1.5) was also signifi cantly
shorter. However, there was no signifi cant difference in the rates of thromboembolic and hemorrhagic
events which may be attributed to a small sample size.
Conclusion: Based on results of our study, a CAC may be the optimal structure for anticoagulation
management service in the future.
- Full text:P020150731525882887124.pdf
