scholarly journals Tele-pharmacy Anticoagulation Clinic During COVID-19 Pandemic: Patient Outcomes

2021 ◽  
Vol 12 ◽  
Author(s):  
Maha Al Ammari ◽  
Khalefa AlThiab ◽  
Manal AlJohani ◽  
Khizra Sultana ◽  
Nada Maklhafi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Therapeutic Range ◽  
Clinical Pharmacist ◽  
Warfarin Dose ◽  
Cost Of Care ◽  
Target Range ◽  
The Mean ◽  
Anticoagulation Control

Introduction: It is well-established that clinical pharmacist-managed anticoagulation services achieve superior anticoagulation control, with a positive impact. At King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, the structure of anticoagulation management is a pharmacist-managed specialty service. With the current COVID-19 situation, measures were taken to assure the continuity of patient care by establishing tele-pharmacy anticoagulation clinics.Materials and Methods: This was a prospective study with patients prescribed anticoagulation and followed up for 3 months. Since establishing the anticoagulation virtual clinic in March 2020, 270 patients were recruited in the study. The data collected included age, gender, comorbidities, indication for anticoagulation, intended duration of treatment, warfarin dose, testing of International Normalized Ratio (INR), INR target, range of INR values, time INR that was within the therapeutic range (TTR), and complications of therapy (bleeding and/or bruises). The patients were asked to complete the pharmacist satisfaction survey (PSS) after their consultation to assess patient satisfaction with the new virtual consultation system. Linguistic and cultural validation was conducted for the questionnaire.Results: A total of 270 patients were included in the study. The mean percentage of overall INR values in the range was 59.39% ± 32.84, and the mean time with the overall INR was within the therapeutic range 57.81% ± 32.08. Thirty-one percent of the sample had good anticoagulation control (time in therapeutic range >70%). The median satisfaction score was 32 (IQR 28–36) with a maximum score of 40.Conclusion: This is the first study to assess the tele-pharmacy anticoagulation clinic’s efficiency and patient satisfaction in Saudi Arabia during the COVID-19 pandemic. This type of consultation was as effective as face-to-face consultations. The study also highlighted that though the reduction in the cost of care was not substantial, there was a significant increase in resource (clinical pharmacist) utilization as a result of this model. The adoption of tele-pharmacy resulted in time savings for the clinical pharmacists who can be utilized in many other improvement projects in adult ambulatory clinics to ensure the delivery of better quality and safe patient care.

scholarly journals Mean Stable Warfarin Doses Versus CYP2C9*2 and VKORC11639G>A Genotypes in Sudanese Population

2016 ◽  
Vol 9 (1) ◽  
pp. 34
Author(s):  
Azza A. M. H. Swar Aldahab ◽  
Abdalla O. Elkhawad ◽  
Ahmed S. A. Elsayed ◽  
Hanan B. Eltahir
Keyword(s):  
Warfarin Dose ◽  
Therapeutic Index ◽  
Target Range ◽  
Wild Type ◽  
Genotype 3 ◽  
Pcr Rflp ◽  
Homozygous Mutant ◽  
Variant Genotype ◽  
The Mean ◽  
Warfarin Dosing

Warfarin is a potent anticoagulant with a confirmed effectiveness when anticoagulation targets are attained, an issue, that is troublesome to reach due to the fact that warfarin has a narrow therapeutic index (NTI), that means they have a narrow window between their effective doses and those at which they produce adverse toxic effects. However, oral anticoagulation throughout genetics recommended a genotype guided dosing, but is it favourable over clinical based dosing? Objectives: To analyze the mean stable warfarin doses attained clinically within CYP2C9*2 and VKORC11639G>A wild-type and variant genotype status in Sudanese patients. Method: Genotyping for the CYP2C9*2 and VKORC1-1639G>A polymorphisms were accomplished with polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) technique. The mean stable warfarin dose per genotype was defined as the mean stable warfarin dose related to the stable INR within target range within a genotype of each of CYP2C9*2 or VKORC11639G> Agenes, using Analysis of Variance (ANOVA) as the statistical method. Results: Fifty-three stable patients with wild-type CYP2C9*1*1 genotype had a mean stable warfarin dose of 4.9 ± 2.1 mg, 5 patients who were heterozygous CYP2C9*1*2 genotype, had a mean stable warfarin dose of 5.0 ± 0.71mg, and 2 patients were homozygous mutant CYP2CP*2*2 genotype had a mean stable warfarin dose of 4.8 ± 0.3 mg. The results were statistically insignificant, P = 0.992.Sixteen unstable patients were of wild-type CYP2C9*1*1 genotype, 40 patients with heterozygous CYP2C9*1*2 genotype, and 4 with homozygous mutant CYP2CP*2*2 genotype, had mean stable doses of 5.32 ± 2.9, 6.5 ± 2.7 and 4.5 ± 0.71 mg respectively. The result was statistically insignificant, P = 0.508. Fifty-two stable patients were having wild-type VKORC1G/G genotype, 3 patients had heterozygous VKORC1G/A genotype and 3 patients had homozygous mutant VKORC1/AA genotype, these patients had mean stable doses of 5.41 ± 1.63, 4.8 ± 2.19 and 5.4 ± 0.99 mg respectively. The mean warfarin stable dose among homozygous mutant VKORC1A/A genotype was lower than among wild-type and heterozygous genotype profiles. This result was statistically not significant, P = 0.729.In the unstable group, 8 patients of wild-type VKORC1G/G genotype, had a mean stable warfarin dose of 7.34 ± 3.9 mg, 40 patients of heterozygous VKORC1G/A genotype had a mean stable warfarin dose of 5.21 ± 2.76 mg, and 10 patients of homozygous VKORC1A/A genotype had a mean stable warfarin dose of 4.3 ± 1.83 mg. The result was statistically insignificant, P = 0.067.Conclusion: In our study, as there were no significant differences between warfarin mean stable doses related to different CYP2C9*2 and VKORC11639G>A genotypes, the evidence is not satisfactory to conclude that the conventional use of genotype guided warfarin dosing will correct stable warfarin dose among Sudanese patients.

scholarly journals Patient Satisfaction in Tertiary Private Hospitals in Najran, Kingdom of Saudi Arabia

2017 ◽  
Vol 5 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Jordan H Llego ◽  
Mohammad O Al Shirah
Keyword(s):  
Saudi Arabia ◽  
Patient Satisfaction ◽  
Great Majority ◽  
Kingdom Of Saudi Arabia ◽  
Private Hospitals ◽  
Level Of Satisfaction ◽  
Patient Will ◽  
Tertiary Hospitals ◽  
The Mean ◽  
Meeting Satisfaction

ABSTRACT Aim This study is aimed to assess the level of satisfaction of patients in tertiary private hospitals in Najran, Kingdom of Saudi Arabia. Materials and methods This study used descriptive crosssectional design through a survey questionnaire. Results A great majority (57%) of respondents are male. Almost half (46.7%) of the respondents are 26 to 35 years old, some (30.3%) are more than 35 years old. The majority (54.5%) of hospitalized patients are married. Some (35.8%) of them reached the secondary level and some (31.5%) completed college. A great majority (57.6%) of the respondents’ salary was below 5,000 SR. A great majority pay their hospitalization by themselves (60.6%). Mean scores revealed: For facilities, the mean was 4.12, standard deviation (SD) = 0.85. For general services, the mean was = 4.13, SD= 0.77. The physician services scored mean = 4.06, SD= 0.88. The highest level of satisfaction according to mean is nursing services with mean= 4.22, SD= 0.80 and the lowest among the variables is convenience with mean= 4.05, SD= 0.84. The overall level of patient satisfaction with the services they received indicated by the mean is 3.91, SD= 1.1. Conclusion Researchers conclude that patients catered by the private tertiary hospitals in Najran Saudi Arabia are more of males, at middle adulthood, and are married who reached the secondary level and have an income of below 5,000 SR and have no health insurance. The level of satisfaction of patients in the private tertiary hospitals is satisfactory and that nursing service has the highest satisfaction level, which is very satisfactory. Clinical significance: The findings of this study are beneficial to the success of the organization. A patient who is satisfied will spread his experience to other people. A satisfied patient will also equate to return of investment. Meeting satisfaction of patients will also decrease the risk of malpractice lawsuits. Clinical significance The findings of this study are beneficial to the success of the organization. A patient who is satisfied will spread his experience to other people. A satisfied patient will also equate to return of investment. Meeting satisfaction of patients will also decrease the risk of malpractice lawsuits. How to cite this article Llego JH, Al Shirah MO. Patient Satisfaction in Tertiary Private Hospitals in Najran, Kingdom of Saudi Arabia. Int J Res Foundation Hosp Healthc Adm 2017;5(1):42-46.

scholarly journals Decreased warfarin sensitivity among patients treated with elbasvir and grazoprevir for hepatitis C infection

2019 ◽  
Vol 76 (17) ◽  
pp. 1273-1280
Author(s):  
Douglas D DeCarolis ◽  
Yi-Chieh Chen ◽  
Anders D Westanmo ◽  
Christopher Conley ◽  
Amy A Gravely ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Therapeutic Range ◽  
Antiviral Agents ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Sensitivity Index ◽  
Veterans Health ◽  
Health Administration ◽  
Hepatitis C Infection ◽  
The Mean

Abstract Purpose We previously reported an interaction with warfarin anticoagulation when initiating treatment with direct-acting antiviral agents for hepatitis C infection. A decreased warfarin sensitivity led to subtherapeutic anticoagulation. To study this interaction further, we expanded our research to include patients treated with the combination of elbasvir and grazoprevir concurrent with warfarin anticoagulation and investigated changes in warfarin sensitivity during and after treatment. Methods Using electronic health records of the Veterans Health Administration, patients starting treatment with elbasvir–grazoprevir for hepatitis C infection concurrent with warfarin anticoagulation were identified. Inclusion required stable warfarin anticoagulation prior to 12 weeks of treatment with elbasvir–grazoprevir. A warfarin sensitivity index (WSI) was calculated at the start and end of treatment and 12 weeks after treatment. The primary endpoint was the difference in WSI from pre- to end-treatment. The secondary endpoint was the WSI difference from pretreatment to 12 weeks posttreatment. Changes in International Normalized Ratio, warfarin doses, and time in therapeutic range were measured. Results In the final sample of 43 patients, the mean WSI decreased during treatment from 0.53 to 0.40, or 25.2%. After treatment, the mean WSI rose to 0.51. Although the mean weekly warfarin dose increased from 40.3 to 44.6 mg during treatment, the mean International Normalized Ratio decreased from 2.40 to 1.96, recovering to 2.59 after treatment. The time spent in therapeutic range decreased from 74.1% before treatment to 39.8% during treatment and back to 64.9% 12 weeks posttreatment. Conclusion When elbasvir–grazoprevir was added to stable warfarin anticoagulation, warfarin sensitivity decreased significantly during treatment and returned to baseline after treatment.

scholarly journals The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting

Medicina ◽  
2019 ◽  
Vol 55 (1) ◽  
pp. 15 ◽  
Author(s):  
Gediminas Urbonas ◽  
Leonas Valius ◽  
Gintarė Šakalytė ◽  
Kęstutis Petniūnas ◽  
Inesa Petniūnienė
Keyword(s):  
Atrial Fibrillation ◽  
Health Care ◽  
Primary Health Care ◽  
Anticoagulation Therapy ◽  
Warfarin Dose ◽  
Median Number ◽  
Target Range ◽  
Primary Health ◽  
Anticoagulation Control

Background and objectives: Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. Materials and Methods: This was a retrospective study conducted in nine primary health care centres in Lithuania. Existing medical records of randomly selected adult patients with AF who were treated with warfarin for at least 12 months were reviewed and analysed. Physicians’ decisions to adjust warfarin dose were considered as consistent with the approved warfarin posology if warfarin dose was increased in case of international normalized ratio (INR) <2.0, decreased in case of INR >3.0 or unchanged in case of INR within 2.0 to 3.0. Results: The study population included 406 patients. The mean duration of treatment with warfarin was 5.4 years. The median number of INR measurements per patient per year was 8.0. More than half (57.3%) of available INR values were outside the target range, with 13.6% INR values being above 3.0 and 43.7% INR values—below 2.0. The median time in therapeutic range (TTR) was 40.0%; only 20% of patients had TTR of ≥65%. In about 40% of the cases with INR values outside the target range, no dose corrections were implemented. About 27% of decisions on warfarin dose adjustment were not consistent with the recommended warfarin posology. The median number of INR measurements was lower among patients living in urban areas, while the median TTR was significantly higher in urban patients than in rural patients. In the multivariate regression model, gender, HAS-BLED score and warfarin treatment duration were associated with a TTR of ≥65%. Conclusions: Anticoagulation control is suboptimal in routine clinical practice with a median TTR of 40%. Our findings suggest that there might be a room for improvement of anticoagulation control in primary care.

Anti Xa Monitoring during Treatment with Low Molecular Weight Heparin or Danaparoid: Inter-assay Variability

1999 ◽  
Vol 82 (10) ◽  
pp. 1289-1293 ◽  
Author(s):  
R. Iampietro ◽  
A. M. Woolley ◽  
F. E. Preston ◽  
S. Kitchen
Keyword(s):  
Molecular Weight ◽  
Therapeutic Range ◽  
Low Molecular Weight Heparin ◽  
Assay Method ◽  
Target Range ◽  
Low Molecular Weight ◽  
The Mean ◽  
The Relationship ◽  
Higher Doses ◽  
Selection Of

SummaryIf laboratory monitoring of low molecular weight heparin (LMWH) therapy is required the test of choice is the anti Xa activity assay. The relationship between anti Xa results obtained using different techniques is unknown. The aim of the present study was to compare anti Xa results obtained with eight different commercially available anti Xa activity assays (five chromogenic and three clotting based assays) in samples from patients receiving either therapeutic or prophylactic LMWH (enoxaparin or dalteparin) or danaparoid.We have demonstrated that highly significant differences exist between results obtained using different techniques. The mean anti Xa activity in patients receiving treatment or prophylaxis with enoxaparin ranged from 0.28 to 0.64 iu/ml. A similar relationship was present in samples from patients treated with dalteparin, mean anti Xa results ranging from 0.43 to 0.69 iu/ml. The Heptest clotting assay as used here in combination with the Automated Coagulation Laboratory instrument, was associated with lower results than other clotting or chromogenic techniques. In patients receiving danaparoid for heparin induced thrombocytopaenia (HIT) mean results with three clotting based assays were 0.30 to 0.36 u/ml, compared to mean results of 0.47 to 0.65 u/ml for chromogenic assays.Our data clearly indicate that the selection of anti Xa assay method could influence patient management since the dose required to achieve the therapeutic range would differ according to the assay employed. This is particularly important since the frequency of hamorrhagic side effects has been shown by others to be dose dependant, irrespective of the concomitant anti Xa activity results. In danaparoid therapy the clotting assays studied here should not be employed for monitoring without a modified target range, unless it can be demonstrated that the higher doses required to achieve the therapeutic range are safe.

scholarly journals Evaluation of Anticoagulation Control among Patients Taking Warfarin in University of Gondar Hospital, Northwest Ethiopia

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zelalem Liyew ◽  
Abilo Tadesse ◽  
Nebiyu Bekele ◽  
Tewodros Tsegaye
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Therapeutic Range ◽  
Multivariate Logistic Regression Analysis ◽  
Warfarin Dose ◽  
Northwest Ethiopia ◽  
Dose Titration ◽  
Cross Sectional ◽  
Anticoagulation Control

Introduction. Warfarin is a widely used oral anticoagulant in clinical practice. It has variable intraindividual and interindividual dose response and a narrow therapeutic index. Therefore, it requires frequent and regular international normalized ratio (INR) determination to maintain the INR within the therapeutic range. The study evaluated parameters of anticoagulation control among patients on warfarin. Methods. A cross-sectional study was conducted at University of Gondar hospital. A consecutive sampling method was used to recruit study subjects. The anticoagulation control was evaluated by determining the proportion of desired INRs and the proportion of time spent in the therapeutic range (TTR). Logistic regression analysis was used to identify associated factors with adequate TTR. A P value <0.05 was used to declare significant association. Result. A total of 338 study subjects were included in the study. The mean age of patients was 48.8 (SD = 16.4) years. Atrial fibrillation was the commonest indication for warfarin therapy. One-third (33%) of study subjects achieved the desired INRs of 2.0–3.0, while about one-tenth (13%) of patients attained good INR control (TTR ≥ 65%). Multivariate logistic regression analysis revealed no significant association of sociodemographic and clinical characteristics with good TTR outcome. Conclusion. The level of anticoagulation control with warfarin among study subjects was very low. The authors recommend to implement a validated warfarin-dose titration protocol and to establish anticoagulation clinics to mitigate the low anticoagulation level.

scholarly journals Mean Stable Warfarin Doses Versus CYP2C9*2 and VKORC11639G>A Genotypes in Sudanese Population

2016 ◽  
Vol 9 (1) ◽  
pp. 34
Author(s):  
Azza A. M. H. Swar Aldahab ◽  
Abdalla O. Elkhawad ◽  
Ahmed S. A. Elsayed ◽  
Hanan B. Eltahir
Keyword(s):  
Warfarin Dose ◽  
Therapeutic Index ◽  
Target Range ◽  
Wild Type ◽  
Genotype 3 ◽  
Pcr Rflp ◽  
Homozygous Mutant ◽  
Variant Genotype ◽  
The Mean ◽  
Warfarin Dosing

Warfarin is a potent anticoagulant with a confirmed effectiveness when anticoagulation targets are attained, an issue, that is troublesome to reach due to the fact that warfarin has a narrow therapeutic index (NTI), that means they have a narrow window between their effective doses and those at which they produce adverse toxic effects. However, oral anticoagulation throughout genetics recommended a genotype guided dosing, but is it favourable over clinical based dosing? Objectives: To analyze the mean stable warfarin doses attained clinically within CYP2C9*2 and VKORC11639G&gt;A wild-type and variant genotype status in Sudanese patients. Method: Genotyping for the CYP2C9*2 and VKORC1-1639G&gt;A polymorphisms were accomplished with polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) technique. The mean stable warfarin dose per genotype was defined as the mean stable warfarin dose related to the stable INR within target range within a genotype of each of CYP2C9*2 or VKORC11639G&gt; Agenes, using Analysis of Variance (ANOVA) as the statistical method. Results: Fifty-three stable patients with wild-type CYP2C9*1*1 genotype had a mean stable warfarin dose of 4.9 ± 2.1 mg, 5 patients who were heterozygous CYP2C9*1*2 genotype, had a mean stable warfarin dose of 5.0 ± 0.71mg, and 2 patients were homozygous mutant CYP2CP*2*2 genotype had a mean stable warfarin dose of 4.8 ± 0.3 mg. The results were statistically insignificant, P = 0.992.Sixteen unstable patients were of wild-type CYP2C9*1*1 genotype, 40 patients with heterozygous CYP2C9*1*2 genotype, and 4 with homozygous mutant CYP2CP*2*2 genotype, had mean stable doses of 5.32 ± 2.9, 6.5 ± 2.7 and 4.5 ± 0.71 mg respectively. The result was statistically insignificant, P = 0.508. Fifty-two stable patients were having wild-type VKORC1G/G genotype, 3 patients had heterozygous VKORC1G/A genotype and 3 patients had homozygous mutant VKORC1/AA genotype, these patients had mean stable doses of 5.41 ± 1.63, 4.8 ± 2.19 and 5.4 ± 0.99 mg respectively. The mean warfarin stable dose among homozygous mutant VKORC1A/A genotype was lower than among wild-type and heterozygous genotype profiles. This result was statistically not significant, P = 0.729.In the unstable group, 8 patients of wild-type VKORC1G/G genotype, had a mean stable warfarin dose of 7.34 ± 3.9 mg, 40 patients of heterozygous VKORC1G/A genotype had a mean stable warfarin dose of 5.21 ± 2.76 mg, and 10 patients of homozygous VKORC1A/A genotype had a mean stable warfarin dose of 4.3 ± 1.83 mg. The result was statistically insignificant, P = 0.067.Conclusion: In our study, as there were no significant differences between warfarin mean stable doses related to different CYP2C9*2 and VKORC11639G&gt;A genotypes, the evidence is not satisfactory to conclude that the conventional use of genotype guided warfarin dosing will correct stable warfarin dose among Sudanese patients.

Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

2014 ◽  
Vol 4 (1) ◽  
pp. 23-29
Author(s):  
Constance Hilory Tomberlin
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Health Care System ◽  
Gulf Coast ◽  
New Technology ◽  
Cost Effective ◽  
Veterans Health ◽  
Potential Benefits ◽  
Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

Predicting the Dose of Warfarin for Therapeutic Anticoagulation

1982 ◽  
Vol 47 (03) ◽  
pp. 230-231 ◽  
Author(s):  
N K Sharma ◽  
P A Routledge ◽  
M D Rawlins ◽  
D M Davies
Keyword(s):  
Therapeutic Range ◽  
Significant Relationship ◽  
Maintenance Dose ◽  
Warfarin Dose ◽  
Loading Dose ◽  
Intravenous Injections ◽  
Therapeutic Anticoagulation ◽  
Close Relationship ◽  
The Relationship ◽  
Anticoagulant Response

SummaryThe validity of a previously described technique for predicting warfarin requirements based on the anticoagulant response to a fixed loading dose was assessed prospectively in 57 patients. There was a close relationship between the predicted and initially observed daily warfarin dose required to maintain the patient within the therapeutic range for anticoagulation. The significant relationship between predicted and observed maintenance dose persisted at 4 and 12 weeks although it decreased with increasing time.The relationship between observed and predicted maintenance requirement of warfarin was not affected by the concomitant use of intermittent intravenous injections of heparin when 9 hr was allowed to elapse between the previous dose of heparin and the thrombotest estimation on which the prediction was based.It is concluded that the method is valuable in predicting an individual’s warfarin requirement, although it does not obviate the need for regular monitoring of anticoagulant control.

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