Document Detail


Impact of a pharmacist-led warfarin self-management program on quality of life and anticoagulation control: a randomized trial.
MedLine Citation:
PMID:  23033226     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To evaluate the impact of a pharmacist-led warfarin patient self-management program on quality of life and anticoagulation control compared with management in a physician-led specialized anticoagulation clinic.
DESIGN: Prospective, randomized, controlled, open-label trial.
SETTING: Tertiary care academic medical center.
PATIENTS: A total of 114 patients aged 18-75 years who were followed at a specialized anticoagulation clinic, had received warfarin for at least 6 months, and were expected to continue warfarin for a minimum of 4 months.
INTERVENTION: All patients attended an educational session on anticoagulation provided by a pharmacist. Patients randomized to the self-management group (58 patients) also received practical training to use the CoaguChek XS device and a self-management dosing algorithm. Patients in the control group (56 patients) continued to undergo standard management at the anticoagulation clinic.
MEASUREMENTS AND MAIN RESULTS: Patients completed a validated quality-of-life questionnaire and the validated Oral Anticoagulation Knowledge test at the beginning and end of the study. The quality of anticoagulation control was evaluated by using the time spent in therapeutic range. After 4 months of follow-up, a significant improvement in the self-management group was observed compared with the control group in four of the five quality-of-life topics (p<0.05). Improvements in knowledge were observed in both groups after the training session and persisted after 4 months (p<0.05 for all). The time spent in the therapeutic range (80.0% in the self-management group vs 75% in the control group, p=0.79) and in the extended therapeutic range ([target international normalized ratio ± 0.3] 93.2% in the self-management group vs 91.1% in the control group, p=0.30) were similar between groups.
CONCLUSION: A self-management warfarin program led by pharmacists resulted in significant improvement in the quality of life of patients receiving warfarin therapy as well as a reduction in the time required for anticoagulation monitoring, while maintaining a level of anticoagulation control similar to a high-quality specialized anticoagulation clinic.
Authors:
Lucie Verret; Justine Couturier; Andréanne Rozon; Sarah Saudrais-Janecek; Amélie St-Onge; Angela Nguyen; Arsène Basmadjian; Simon Tremblay; Denis Brouillette; Simon de Denus
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pharmacotherapy     Volume:  32     ISSN:  1875-9114     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-03     Completed Date:  2013-02-27     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  871-9     Citation Subset:  IM    
Copyright Information:
© 2012 Pharmacotherapy Publications, Inc.
Affiliation:
Department of Pharmacy, Montreal Heart Institute-Université de Montréal, Montreal, Quebec, Canada. lucie.verret@icm-mhi.org
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT01033279
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MeSH Terms
Descriptor/Qualifier:
Academic Medical Centers
Adolescent
Adult
Aged
Anticoagulants / administration & dosage*,  adverse effects,  therapeutic use
Epistaxis / chemically induced,  prevention & control
Female
Follow-Up Studies
Hospitals, Special
Humans
International Normalized Ratio / instrumentation*
Male
Middle Aged
Outpatient Clinics, Hospital
Patient Education as Topic / manpower*
Pharmacists*
Quality of Life*
Quebec
Self Administration
Self Care / instrumentation*
Warfarin / administration & dosage*,  adverse effects,  therapeutic use
Young Adult
Chemical
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin
Comments/Corrections
Erratum In:
Pharmacotherapy. 2013 Apr;33(4):464

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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