Until recently,
Prothrombin Time/International Normalized Ratio (PT/INR) measurements
have typically been used to monitor patients on warfarin through
institutional laboratories via venous puncture. The Point-of-Care
Testing (POCT) device has revolutionized the patient care process
by allowing for laboratory testing outside of the central laboratory.
Objective: To analyze humanistic and clinical outcomes in patients
currently treated with warfarin and monitored through a pharmacist-managed
anticoagulation clinic using point-of-care testing (POCT) device
versus venipuncture within ambulatory care clinics at our institution.
Methods: All patients currently treated with warfarin therapy
who were managed by clinical pharmacists for anticoagulation monitoring
at the Medical University of South Carolina (MUSC) Family Medicine
Center and University Diagnostic Center, were enrolled. Patients
were asked to complete a satisfaction survey regarding their anticoagulation
monitoring. In addition, data related to emergency department
(ED) visits, hospitalizations and percent of time in the INR therapeutic
range for 6 months pre- and post-implementation of POCT device
was collected. This information was obtained through an electronic
patient information database, Oacis.
Results: A total of 145 patients were included in the data collection
from the two clinics. The majority (41%) of these patients were
taking warfarin for atrial fibrillation. Satisfaction surveys
were completed by 86 (59 %) of patients. The surveys revealed
that POCT device was preferred over venipuncture in 95% of patients.
Reasons for the preference included more face-to-face interaction,
less wait time, less pain, less blood needed, and quicker results.
Of the 145 patients who were included in the objective data analysis,
no significant differences were found in the number of hospitalizations,
ED visits, or percent of time in the INR therapeutic range pre-
and post- implementation of POCT device.
Conclusion: The results of this study demonstrate improvement
in patient satisfaction with POCT compared to venipuncture, with
limited value in clinical outcomes.
