Many veterans with some types of blood clotting conditions need to take blood thinners or anticoagulants. Warfarin, an anticoagulant is one of the most frequently prescribed drugs in the U.S. with more than 17.8 million prescriptions dispensed annually to prevent strokes or heart attacks. Once warfarin therapy begins, the International Normalized Ratio (INR) must be tested periodically to ensure the proper warfarin dosing.
To address the problem, a pilot project was funded by the VA’s Office of Rural Health, enabling the West Texas VA Health Care System to create a Telehealth Anticoagulation Clinic to help veterans currently taking blood thinners. The goal is to improve the clinical care received by veterans in rural and highly rural areas while developing a program flexible enough to handle the population shifts at multiple locations.
About 600 veterans within the 55,000 square mile primary service area of the West Texas VA Health Care System are enrolled in the telehealth clinic. Veterans routinely report to the West Texas VA Medical Center or to one of the Community Based Outpatient Clinics to have regular blood draws to check the INR levels monthly with results available to Dr. Jason Cornish, the Clinical Pharmacist in Big Spring. Then the results are sent to the veteran’s provider within 24 to 48 hours.
The Clinical Pharmacist discusses the results with the veteran at a different location using a telehealth unit. The patient and Clinical Pharmacist both use a computer screen during this communication and then adjustments are made to the veteran’s medication immediately if needed.
Although the Pharmacist managed anticoagulation clinic has only been in full implementation at distant sites for a few months, the results have been very successful. Significant improvements in INR control have been demonstrated at all the clinics and significant improvements have been demonstrated in decreasing the number of critical INR values.