Impact of a pharmacist-led warfarin self-management program on quality of life and anticoagulation control: a randomized trial.

Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 8111305 Publication Model: Print Cited Medium: Internet ISSN: 1875-9114 (Electronic) Linking ISSN: 02770008 NLM ISO Abbreviation: Pharmacotherapy Subsets: MEDLINE

Publication: 2012- : Malden, MA : Wiley-Blackwell
Original Publication: [Carlisle, MA : Pharmacotherapy Publications, c1981-

Patient Education as Topic* ; Pharmacists* ; Quality of Life*; Anticoagulants/*administration & dosage ; International Normalized Ratio/*instrumentation ; Self Care/*instrumentation ; Warfarin/*administration & dosage; Academic Medical Centers ; Adolescent ; Adult ; Aged ; Anticoagulants/adverse effects ; Anticoagulants/therapeutic use ; Epistaxis/chemically induced ; Epistaxis/prevention & control ; Female ; Follow-Up Studies ; Hospitals, Special ; Humans ; Male ; Middle Aged ; Outpatient Clinics, Hospital ; Quebec ; Self Administration ; Warfarin/adverse effects ; Warfarin/therapeutic use ; Workforce ; Young Adult

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.
(© 2012 Pharmacotherapy Publications, Inc.)

Erratum in: Pharmacotherapy. 2013 Apr;33(4):464.

ClinicalTrials.gov NCT01033279

0 (Anticoagulants)
5Q7ZVV76EI (Warfarin)

Date Created: 20121004 Date Completed: 20130227 Latest Revision: 20220311

20240628

10.1002/j.1875-9114.2012.01116

23033226