Discussion
This study showed no statistically significant differences in TTR for patients switched to the telephone anticoagulation clinic from the face-to-face anticoagulation clinic. There also were no statistically significant differences in event rates for CVA/TIA, VTE, or major bleeds. The only statistically significant difference in secondary endpoints was better compliance with LFT monitoring in the telephone clinic period. Additionally, patients served as their own control in this study, which helped eliminate confounding factors that may have been present when comparing 2 different patient groups.
The telephone clinic offered patients multiple advantages, including decreased wait time, as patients did not have to wait for their laboratory results to return or wait to be seen in clinic, increased volume of patients managed due to shorter appointment times, better coordination of other appointments on the same day, and improved medication reconciliation when patients have their medications in front of them. The disadvantages of telephone anticoagulation clinic included the inability of the providers to see any nonverbal cues, difficulty evaluating other issues for patients already at home and unwilling to return to the clinic, and the inability to provide written information (eg, changes in warfarin dosing or appointment scheduling) to the patient during the visit.
Limitations
In addition to the sample size and retrospective design of the study, there were several other study limitations. When the telephone anticoagulation clinic first started, patients with more stable INRs were chosen to enroll, which may have led to selection bias. Other limitations included the lack of documentation, patient reporting, or outside medical records documenting bleeds, VTE, or CVA/TIA. In addition, power was not calculated prior to beginning the study, because only, a small patient pool was available, and all patients that met inclusion criteria were to be included. Therefore, the sample size may have been too small to detect a difference.
Conclusion
In this retrospective chart review, the JBVAMC patients using the face-to-face and telephone anticoagulation clinics had similar outcomes. Telephone anticoagulation clinic was shown to be a viable alternative for some patients.