Appointment attendance and patient perception of drive-up INR testing in a rural anticoagulation clinic during the COVID-19 pandemic

• Main Authors: Carson, E. (Author), Hunt, A. (Author), MacDowell, M. (Author), Reeder, A. (Author), Zobeck, B. (Author)
• Format: Article
• Language: English
• Published: Blackwell Publishing Ltd 2021
• Subjects: aged; ambulatory care; anticoagulant therapy; Article; cohort analysis; controlled study; coronavirus; coronavirus disease 2019; COVID-19; cross-sectional study; drug monitoring; female; follow up; health care survey; human; infection risk; international normalized ratio; major clinical study; male; medication compliance; pandemic; patient attendance; patient compliance; patient preference; patient satisfaction; patient volume; perception; pharmacists; priority journal; retrospective study; rural health care; telehealth; telemedicine; traffic and transport; virus transmission; warfarin
• Online Access: View Fulltext in Publisher

 Introduction: The Anticoagulation Forum and Centers for Disease Control and Prevention (CDC) recommend drive-up international normalized ratio (INR) testing to combat INR non-adherence and increase safety during the coronavirus disease 2019 (COVID-19) pandemic. Patient perceptions and impact on attendance have not been studied. Objective: To assess appointment volume and patient perception after initiation of drive-up INR testing in a rural pharmacist-managed anticoagulation clinic. Methods: This cross-sectional cohort survey study offered each patient attending the anticoagulation clinic via drive-up or in-office visit a survey between May 27 and July 2, 2020. Patients testing off-site were excluded. Study end points included monthly patient volume, visit type preference, testing barriers, desired drive-up duration, and overall clinic satisfaction. Clinic appointment volume from October 2019 to June 2020 was collected retrospectively through a schedule review. Results: Sixty-four (80%) of 80 surveys offered were completed: 46.6% of respondents preferred drive-up testing, 26.7% indifferent, and 26.7% preferred in-office visits; 38.7% of respondents indicated a greater likelihood of continuing routine INR monitoring via drive-up testing. Of the respondents completing the survey curbside, 46% and 27% of respondents identified reduced COVID-19 transmission risk and ease of transportation as benefits of drive-up INR testing, respectively. March and April clinic volumes were 19% and 22% below average, respectively, returning to baseline after drive-up testing was implemented. Clinic rating before and after drive-up testing remained high at 2.75 on a scale of 0-3. While infection risk was identified as the biggest barrier to care by 32.8% of respondents, 59.3% of all respondents wanted drive-up testing to continue indefinitely. Conclusions: Drive-up INR testing improves patient attendance during the COVID-19 pandemic. Patient perception of drive-up testing is positive. About 46% of respondents preferred drive-up INR testing with telehealth follow-up and 59.3% of respondents want drive-up testing to continue indefinitely, which suggests this approach to INR testing as a potential method to allay barriers to routine monitoring beyond the scope of the pandemic. © 2021 Pharmacotherapy Publications, Inc.