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首页> 外文期刊>Journal of pharmacy practice >Clinical and Financial Outcomes Evaluation of Multimodal Pharmacist Warfarin Management of a Statewide Urban and Rural Population
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Clinical and Financial Outcomes Evaluation of Multimodal Pharmacist Warfarin Management of a Statewide Urban and Rural Population

机译：国内城市和农村人口多式化药剂师华法林管理的临床和财务结果

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Purpose: To evaluate the efficacy, safety, and indirect financial outcomes of pharmacist face-to-face warfarin management with telephone-based distance management utilizing local laboratories or patient self-testing (PST). Methods: A retrospective analysis of a clinic population of 336 patients on established warfarin therapy distributed statewide in rural and urban settings over a 6-month period was conducted. Participants were stratified into face-to-face management, telephone-based management utilizing local laboratory testing, and telephone-based management utilizing PST. Results: The primary outcome of international normalized ratio (INR) time in therapeutic range (TTR) for face-to-face management was significantly greater than distance management utilizing local laboratory testing (69.0% vs 60.5%, P = .0032). No difference was observed between face-to-face management and PST (69.0% vs 68.0%, P = .25). No significant difference in bleeding or thromboses was observed. Although increased clinician time was utilized during face-to-face encounters compared to telephone encounters (8.7-minute face-to-face, 5.5-minute local laboratory, and 5.4-minute PST), face-to-face encounters tended to be billable at lower levels, whereas telephone-based encounters were billable at higher levels. Conclusion: A multimodal approach to pharmacist warfarin management of a patient population distributed statewide in rural and urban locations is effective despite TTR differences associated with INR testing used in distance management. PST may improve warfarin treatment outcomes and adherence in distance management, particularly when the use of alternative oral anticoagulants is inappropriate. Although time and billing differences between face-to-face and distance management exist, clinical and safety outcomes remain acceptable despite encounter complexity and support reimbursement of pharmacist anticoagulation management in all settings.
机译：目的：利用当地实验室或患者自检（PST）评估药剂师面对面华法林管理的疗效，安全和间接金融结果与基于电话的远程管理。方法：对336名患者的临床分析进行了336名患者在农村和城市环境中分布在一个6个月的城市环境中分布的临床患者。参与者分为面对面管理，利用当地实验室检测和利用PST的电话管理管理。结果：面对面管理的治疗范围（TTR）中的国际归一化比率（INR）时间的主要结果明显大于利用当地实验室检测的距离管理（69.0％Vs 60.5％，P = .0032）。面对面管理和PST之间没有观察到差异（69.0％与68.0％，p = .25）。观察到出血或血栓形成显着差异。虽然与电话遭遇相比，在面对面遭遇期间使用的临床医生时间增加（面对面面对8.7分钟，地方实验室和5.4分钟的PST），面对面遭遇往往是可计入的在较低的水平，而基于电话的遭遇在更高的水平上是可计入的。结论：患者患者人口的药剂师华法林管理的多模式方法在农村和城市地区分布的州全州，尽管远程管理中使用的INR测试有关的TTR差异是有效的。 PST可以改善华法林治疗结果和遵守远程管理的粘附，特别是当使用替代口腔抗凝血剂不合适时。尽管存在面对面和距离管理之间的时间和结算差异，但仍然可以接受临床和安全结果，尽管在所有环境中遇到复杂性和支持药剂师抗凝管理的复杂性和偿还。

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