Helping manage anticoagulation patients for over 19 years

How to Setup a Virtual Anticoagulation Clinic

7/20/2007 4:18:15 PM - Virtual anticoagulation clinics are becoming very popular as an effective approach to manage warfarin patients, primarily using phone consultations and electronic databases, in a centralized community location. One such clinic in Cedar Rapids, Iowa, The Community Anticoagulation Therapy (CAT) Clinic, was created solely as a virtual clinic in 2005. The CAT Clinic developed the documentation and infrastructure based on the best practices of other clinics across the country. The clinic has no direct patient contact on site, following the initial evaluation and registration.

The goal of the CAT clinic is to provide patients with efficient and high quality services in managing their Coumadin/warfarin, while maintaining the structure to comply with future ISO-9000 requirements.

Highlights of the clinic:

  • Initial extensive face-to-face visit to assess a patient's medical history and “brown bag” review of all medications
  • Individualized educational session to discuss our patient education booklet “My Guide to Warfarin Therapy”
  • Coumadin/warfarin adjustments. The CAT Clinic uses the American College of Chest Physicians guidelines, and notify the referring physician each time an adjustment is made.
  • Use of teach-back method. The CAT Clinic staff ask all patients to repeat back what is taught, or demonstrate a task that has been discussed.
  • INR Pro database, that includes a reminder system for the patient's next INR. The data base also utilizes an INR control chart. The control charts assists the CAT Clinic nurse in dosing decisions. The database includes several reports, including percent in INR range (using three different methods, Rosendaal, Cross-Section, and Traditional). The reports can be accessed easily by entering a date range.
  • Compliance assessment. Patients assess their diet (too much or too little vitamin K), missed or extra doses, addition of an antibiotic, addition or discontinuance of amiodarone addition of herbal supplements, alcohol consumption, and addition or discontinuance of ASA or NSAIDS.

Patient satisfaction with services of the CAT clinic are 100%. Providers also are 100% satisfied. The percentage of patients maintaining their INR range is 51.4% (Rosendaal method) compared to 43.3% prior to enrollment in the CAT Clinic.

Preliminary data from the CAT Clinic also demonstrates that patients who participate in the clinic:

  • Are less likely to miss a Coumadin/warfarin dose
  • Have fewer dose changes
  • Maintain their dietary intake of vitamin K more consistently
  • Understand the importance of contacting the clinic when they have health-related questions.
  • Experience fewer bleeding and clotting events
  • Are less likely to be hospitalized or need to use the emergency room because of their anticoagulation therapy.

If you are interested in setting up a virtual clinic, you will need the following items:

  1. INR Pro (of course!)

  2. Process Documentation, Forms and Templates - these forms, procedures and documents are available for purchase, to reduce the amount of time to get your clinic setup.

  3. Consultation Support and Expertise - Visit the CAT Clinic website for contact information to get support and lessons learned for your clinic, from those who have been through it already.

INR Pro - patient anticoagulation tracking systemIf you would like to take advantage of these features with INR Pro, try our demo, or contact us for more information.