None listed
Conditions
Brief summary
Warfarin is a difficult drug to manage safely especially when commenced. The Australian population is ageing and the use of warfarin particularly in the elderly as a treatment for stroke prevention is increasing. Furthermore changing treatment trends have resulted in shorter hospital stays which has increased the risk for warfarin patients who are being discharged before achieving a stable and effective warfarin level. This study will compare a control group following the usual care post discharge pathway with an intervention group receiving the proposed best practice discharge pathway. This will include a home medication review from an accredited pharmacist and follow-up checking of the INR of patients using a portable monitor within their home. Result will be referred to the patient's GP for evaluation. Outcomes such as bleeding and clotting events as well as unplanned hospital re-admission will be compared between the two groups. A small group of thirty of the intervention patients will, if consenting and able, be trained to perform self monitoring of the INR in their homes. The results obtained will be forwarded to their GP on a weekly basis for evaluation and possible warfarin dosage adjustment.
Interventions
A proposed best practice discharge pathway for patients either initiated on warfarin in hospital or whose treatment with warfarin was disrupted due to hospitalisation.
Currently, the usual management of patients taking warfarin who are discharged from hospital into the community involves providing the patient with a medication discharge sheet and notifying the general practitioner (GP) of the patient's condition requiring warfarin, their warfarin dose, their International Normalised Ratio (INR)
A proposed best practice discharge pathway for patients either initiated on warfarin in hospital or whose treatment with warfarin was disrupted due to hospitalisation. Currently, the usual management of patients taking warfarin who are discharged from hospital into the community involves providing the patient with a medication discharge sheet and notifying the general practitioner (GP) of the patient's condition requiring warfarin, their warfarin dose, their International Normalised Ratio (INR) at discharge and recommended dosage regimen for warfarin for that patient. Patient's routinely have follow-up pathology tests organised by their GP to monitor their INR levels and these are normally more frequent to begin with but taper to a once monthly pathology check once the patient's INR has stabilised. Unfortunately incomplete or misdirected information together with patient misunderstanding have resulted in inadequate or incorrect patient care. Often community pharmacies are overlooked in the discharge process. This study will include, in addition to this usual care, a home follow-up medication review by an accredited pharmacist with an emphasis on patient warfarin education. Additionally a trained accredited pharmacist will take up to three measurements of the INR, two or three days apart, using a portable monitor. This will occur within the first 10 days of the patient's discharge. Feed back to the patient's GP will be provided in each instance. A final visit 90 days after discharge will be used to assess outcomes. Thirty suitable and consenting patients will then be trained to use a point of care monitor to measure their INR in the home. Result obtained will be sent to their GP on a weekly basis over 90 days for his consideration.
Sponsors
The Unit for Medication Outcomes Research and Education, University of Tasmania
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Minimum age :18years Maximum age: no limit Gender: both males and females Health: must have had their warfarin treatment disrupted due to hospitalisation or have been initiated on warfarin.
Exclusion criteria
Language; Non English speaking Other studies: Participation in a concurrent other study. Demographics; not-home based on discharge or no GP Dementia.
Outcome results
None listed