ABSTRACT
Introduction: the health emergency caused by the COVID-19 pandemic has forced health providers to rethink and reformulate patients' care management, particularly during lockdown, in view of the need of stronger interactions between hospitals and local medical care with the aim of reducing the number of patients' accesses to the hospitals. Patient under oral anticoagulant therapy, particularly those treated with antivitamin K drugs (AVK), need continuous therapy monitoring and drug dose adjustment, thus increasing their risk of possible SARS-CoV-2 exposure during the visits to the hospitals. The aim of this study is to illustrate, using appropriate indicators, the outcomes of an alternative clinical management of anticoagulated patients, adopting a new organizational model and an extended use of digital tools. Method(s): a dedicated telephone number and a digital platform for therapy issuing were activated to maintain continuous patient surveillance and counselling activity. Specific indicators were: number of telephone calls received;number of digital therapy prescriptions;time in range (TTR) of AVK patients;number of major adverse events. Result(s): during the pandemic phase 10 215 telephone calls were received (with an increase of 200% compared to the pre-pandemic era). When compared to the values observed in the pre-pandemic period, the values of the indicators remained stable during the pandemic phase: TTR of AVK patients was 74% versus 74.6%;22 minor and 2 major bleeding events were recorded versus 21 and 2 respectively. Discussion(s): the results obtained show, from the patient side, an optimal acceptance of the model proposed and, from the clinical side, the maintenance of the pre-pandemic quality standards of care. Copyright © 2022 Biomedia. All rights reserved.
ABSTRACT
Background: The emergency caused by the Covid-19 pandemic has forced the reformulation of the operating methods of the Health System, turning the spotlight on the need for greater interaction between hospital and territory. This aspect is even more evident in patients needing for a more strict followup as those under antithrombotic therapy (TAO), making clear the essential usefulness of digital tools and of new organizative models. Objectives: Minimize the risks for adverse events in patients on oral anticoagulant therapy with vitamin K inhibitor drugs (AVK) or direct oral anticoagulants (DOAC), maintaining an optimal level of clinical / consulting support, allowing accurate monitoring of compliance and managing both hemorrhagic and thrombotic emergencies remotely, in order to reduce access to the Emergency Room (when possible) and to hospital facilities. Methods: The patients in charge at the Thrombosis Center of the San Paolo Hospital in Savona (FCSA 123) are in total 781: 66% diagnosed with atrial fibrillation (FA), 20% for the presence of mechanical or biological valve prostheses and 14% for thrombotic pathologies such as deep vein thrombosis (DV) and pulmonary embolisms (EP). 560 patients are in DOAC, while 221 patients in AVK. During the pandemic, a dedicated mobile telephone number was activated (twelve hours/day from 8 am to 8 pm) equipped with an instant messaging application service. Each patient was asked for an email address and signed consent to the computerized management of TAO therapy and forwarding of health documents. Results: In order to monitor the expected results, the following indicators were evaluated: number of incoming phone calls;number of treatment plans issued for DOAC;time in range for patients in AVK;number of complications recorded in the period under review (April 2020 -April 2021). The results obtained are respectively: about 9000 phone calls received;560 treatment plans released;time in range from patients in AVK (TTR) 74%;22 adverse events including two major hemorrhages. Conclusions: The new organization, based on digital support of clinical monitoring, has received high appreciation from patients and consequently a greater compliance with the therapy protocol. This management model has allowed an effective control both of the number and severity of adverse events, while the reduction of outpatient access has allowed to drastically reduce the infectious risk. In addition, e-mailing of reports and treatment plans allowed an optimization of human resources.