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Outcomes of Oral Anticoagulant Therapy Managed by Telephone vs In-Office Visits in an Anticoagulation Clinic Setting^*

^* From the School of Pharmacy (Dr. Wittkowsky) and the Medical Center (Dr. Mullins), University of Washington, Seattle, WA; and the College of Pharmacy (Drs. Nutescu, Blackburn, Hardman, Mitchell, and Vats), University of Illinois at Chicago, Chicago IL.

Correspondence to: Edith A. Nutescu, PharmD, The University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, 833 S Wood St, M/C 886, Chicago, IL; e-mail: enutescu{at}uic.edu

Abstract

Background: Anticoagulation management by a dedicated anticoagulation clinic improves patient outcomes compared to routine medical care. Telephone-based anticoagulation management has been described but has not been compared to management with traditional office-based visits. The objective of this study was to compare warfarin-related monitoring outcomes, clinical end points, and the use of health-care resources as a result of warfarin-related complications in anticoagulation clinic patients whose management was conducted by telephone or in-office-based visits.

Setting: Two university-affiliated anticoagulation clinics in Seattle, WA, and Chicago, IL.

Methods: A retrospective, observational cohort design was used to investigate anticoagulation clinic patients who were managed by telephone encounters compared to those managed during face-to-face in-office encounters.

Results: A total of 234 patients were evaluated; 117 patients managed by telephone were compared to 117 patients managed in office-based clinic visits. Monitoring outcomes (ie, time in therapeutic range and clinic visits per patient-year) were similar between groups. Differences in major bleeding (5.67% vs 5.62% per patient-year, respectively) and thromboembolic events (1.42% vs 2.81% per patient-year, respectively) between telephone-managed and face-to-face-managed patients did not reach statistical significance. The same was true for differences in the frequency of emergency department visits and hospital admissions to manage complications of warfarin therapy.

Conclusions: Telephone-based management of oral anticoagulation through a pharmacist-staffed anticoagulation clinic yielded clinical outcomes that were at least as favorable as those associated with traditional office-based visits. Telephone follow-up can be successfully used to manage warfarin therapy in patients who are unable to present in person to an anticoagulation clinic.

Key Words: anticoagulation • clinic management • outcomes • telephone management • warfarin