Impact of a New Method of Warfarin Management on Patient Satisfaction, Time, and Cost

• Published in: Pharmacotherapy 2013-11, Vol.33 (11), p.1147-1155
• Main Authors: Meyer, Sarah, Frei, Christopher R., Daniels, Kelly R., Forcade, Nicolas A., Bussey, Marie, Bussey-Smith, Kristin L., Bussey, Henry I.
• Format: Article
• Language: English
• Subjects: Anticoagulants - adverse effects; Anticoagulants - economics; Anticoagulants - therapeutic use; anticoagulation; Biological and medical sciences; cost; Costs and Cost Analysis; Disease Management; Drug Monitoring - economics; Drug Monitoring - methods; Follow-Up Studies; home INR monitoring; Humans; International Normalized Ratio - economics; International Normalized Ratio - methods; Male; Medical sciences; Patient Satisfaction - economics; Pharmacology. Drug treatments; Prospective Studies; Self Care - economics; Self Care - methods; self-testing; Surveys and Questionnaires; Time Factors; warfarin; Warfarin - adverse effects; Warfarin - economics; Warfarin - therapeutic use
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1002/phar.1344

Study Objective International normalized ratio self‐testing with online remote monitoring and management (STORM2) is an alternative to anticoagulation clinic management, but the patient's perspective of this method has not been evaluated in the United States; thus we sought to evaluate the impact of STORM2 on patient satisfaction, time, and cost. Design Prospective pre‐ and postintervention study. Setting Freestanding clinical research center. Patients Forty‐three patients treated with long‐term warfarin therapy and monitored initially in the anticoagulation clinic setting and then with STORM2, referred from 11 medical practices. Intervention Patients were asked to complete a survey and the Duke Anticoagulation Satisfaction Scale (DASS) before (at baseline) and after at least 3 months of STORM2 (at follow‐up). Measurements and Main Results Patient satisfaction and time were assessed by survey and the DASS. Costs were measured from the patient's perspective. Overall 90% of responders preferred STORM2 to traditional clinic management. The DASS questions indicated that patients were more satisfied with their anticoagulation treatment and more likely to recommend oral anticoagulation to a friend after experiencing STORM2. In addition, patients found STORM2 to be less complicated and more convenient than traditional clinic management. For each traditional monthly visit, patients drove 20 miles and expended a total of 1.8 hours; using 55¢/mile for mileage reimbursement and $15/hour for lost wages, the cost for each visit was $38. The total cost for four STORM2 visits per month was $10, for a net savings of $28 per patient per month. A total of 76% of patients were willing to pay additional money to eliminate a monthly clinic visit. Conclusion STORM2 is more convenient, less complicated, preferred by patients, and saves patients time and money compared with clinic management.