Coumadin management by telephone possible: study

NEW YORK (Reuters Health) - Patients treated with the blood-thinning drug Coumadin (warfarin) or like agent can be managed by telephone, with outcomes as good as or better than office-based management, according to a trial in which the two options were directly compared.

The last decade has seen a shift in the care of patients on anti-clotting therapy, from traditional physician-based settings to anticoagulation clinics staffed by pharmacists or nurses, Dr. Edith A. Nutescu at the University of Chicago, and colleagues note.

Outcomes turned out to be better in the clinics, because of more consistent monitoring, early recognition of risk factors, and improved patient education.

Now, some patients on anticoagulation therapy are being managed by telephone consultations. Previous studies showed that telephone management reduces waiting periods, travel time, and travel costs, leading to high patient satisfaction.

To date, no studies have directly compared outcomes of the two treatment strategies, Nutescu and colleagues point out in the journal Chest.

Their research was conducted at two university-based anticoagulant clinics. The investigators emphasize that the "structure and complexity of our telephone-based interview and patient evaluation replicated the model of our in-clinic face-to-face visit."

The trial included 117 patients monitored by office visits and 117 by telephone. Telephone management was chosen for patients who could not be seen in the clinic because of their personal situations. For these patients, a blood test called an INR that tells doctors if the anticoagulant dose being taken is appropriate or not was performed by local laboratories, and results were transmitted to the anticoagulation clinic.

According to the team, telephone management worked just as well as clinic management. During 283.4 patient-years of treatment, none of the evaluated measures differed significantly between groups, including number of INRs in the goal range, frequency of anticoagulation clinic encounters, rates of major bleeding, recurrent blood clots, and number requiring treatment at a hospital.

"This study suggests the effectiveness of telephone-based anticoagulation management by an anticoagulation clinic for patients who are unable to come to the clinic due to distance, transportation, or disability issues," the researchers conclude.

The one hitch in providing telephone-based care, Nutescu's team suggests, is that it may not be reimbursed by third-party payors, making this mode of treatment unfeasible for the providers.

SOURCE: Chest, November 2006.