Clinical Outcomes of Implementation of the Network for Taking Care of Patients Receiving Warfarin among Sawanpracharak Hospital and Community Hospitals
Article Sidebar
Main Article Content
Abstract
Objective: To assess the outcomes of patient care and the safety of using warfarin after establishing a network of care for patients receiving warfarin among Sawanpracharak Hospital and community hospitals. Method: Sawan Pracharak Hospital, the nodal hospital, in collaboration with 12 sub-nodal hospitals who voluntarily joined the network organized warfarin workshop and the meeting on the use of the Warfarin Registry Network (WaRN) to empower personnel in sub-nodal for taking care of patients using warfarin. The evaluation of network implementation was conducted in all patients (N=46) receiving warfarin from the nodal hospital at least four times, with the number of times of INR levels in the treatment target greater than or equal to 50% and having no adverse reactions identified, who were referred to the sub-nodal hospitals for further treatment with no less than four treatments at the sub-nodal hospitals during January 2018 and June 2019. Data were retrospectively collected from patient records. Results: Proportion of number of times of INR (international normalized ratio) within the target range for treatment at the nodal hospital and that in the sub-nodal hospital were not significantly different (44.0% and 45.7%, respectively). Percentages of number of days with INR levels in the target range during treatment in the nodal and sub-nodal hospitals were significantly different (43.01% and 47.94%, respectively, P=0.045). During treatment in the sub-nodal hospitals, mean follow-up day for INR was 49.4 days, which was more frequent than that at the nodal hospital (mean of 65.7 days). In terms of safety of drug use as assessed from the proportion of the number of INR measurement with the levels at risk of severe complications (INR <1.5 or INR> 4.0), there were no differences between that in the nodal and that in sub-nodal hospitals. Conclusion: Establishment of a care network for patients receiving warfarin allows closer patient monitoring in the sub-nodal hospitals with no differences in treatment outcomes from those in the nodal hospital.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
Priksuwan A, Phanthumethamat N, Phanphithong N. Establishment of a warfarin clinic, anticoagula- tion clinic and patient self-testing. In Boonsue N, Carmikael P, Suntharachun T, Editor. Warfarin medication guide for pharmacist in Thoracic Institute. Bangkok: Chest Institute; 2010. p 70-83.
Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 1998; 158: 1641-7.
Wilson SJ, Wells PS, Kovacs MJ, Lewis GM, Martin J, Burton E. Comparing the quality of oral anticoagulant management by anticoagulant clinics and by family physicians: a randomized controlled trial. Can Med Assoc J 2003; 169: 293-8.
Kritathamakul S. Effects of pharmacists counseling in outpatients taking warfarin at Songkhlanakarin Hospital [master thesis]. Bangkok: Chulalongkorn University; 1999.
Baobunjong S. Clinical outcomes of pharmaceutical care in outpatients receiving warfarin in Chiangrai Prachanukroh Hospital [master thesis]. Chiang Mai : Chiang Mai University; 2000.
Sapu U. Outcomes of cooperation between physicians and pharmacists in warfarin use [master thesis]. Bangkok: Mahidol University; 2006.
Chumpon C. Development of the care system for patients receiving warfarin at Sena Hospital in Ayutthaya. In Anon, editors. Academic Conference of the Ministry of Public Health 2010: Sub-district health promoting hospital-A bridge connecting the primary to the tertiary; 2010 Aug 4-6; Phuket, Thailand. Bangkok: National Buddhism Office Publishing; 2010.
Sanglor S, Kunaprasert K. Monitoring of drug use in patients receiving warfarin by hospital pharmacists and nurses at Phra Nakhon Si Ayutthaya. In Anon, editors. Academic Conferences and Annual General Meeting of Pharmaceutical Association Hospital 2010 on the quality of pharmacy services: a major step towards a safe drug system; 2010 Aug 2-4; Bangkok, Thailand. Bangkok : Citizens; 2010.
Sukanantachai B, Sapoo U, Supsinwiwat A, Pongrithsakda W, Tangsriseree N, Kanokhong S. Implementation and outcome evaluation of satellite network of Anticoagulation clinics in Nakornratcha sima province, Thailand. Journal of Health Systems Research 2011; 5: 495-505.
Wattanasombat S. Anticoagulant clinic: A decade of evolution and direction for the future. In Anon, editors. Conference on the development of hospital pharmacy to accommodate the challenges of the new decade; 2012 May 23-25; Bangkok, Thailand. Bangkok: Citizens; 2012.
Wangnirattisai N. Effects of pharmaceutical care in patients receiving warfarin from warfarin clinic at Sawanpracharak Hospital [master thesis]. Chiang Mai: Chiang Mai University; 2017.
Heart Association of Thailand. Guidelines for treating patients with oral anticoagulants [online] . 2010 [cited Dec 6, 2019). Available from: www. thaiheart.org/images/column_1291454908/warfarin_Guideline.pdf
Arayawongchai D, Kaothean T, Siriangkhawut M, Promsupan S. The result of implementing network of care for post operative valvular heart patients who use wafarin. Journal of Health System Research 2012; 6: 125-33.
