Implementation of a Telemedicine Direct Oral Anticoagulant Monitoring Program at a Safety-Net Hospital

Abstract

Purpose: Direct oral anticoagulants (DOACs) are the preferred choice of anticoagulation therapy for nonvalvular atrial fibrillation and venous thromboembolism. Inadequate monitoring of patients on DOACs may lead to suboptimal outcomes and safety concerns. This project aimed to implement a standardized telemedicine-based DOAC monitoring service and track pharmacist-based interventions. Methods: This project was conducted at a safety-net hospital over 6 months. Anticoagulation pharmacists developed a scheduling process for telemedicine DOAC follow-up appointments, integrated them into the electronic health record, and implemented standardized protocols and documentation tools. Outcomes of interest included the average number of pharmacist interventions per encounter and per patient. Results: One hundred sixty-four encounters involving 120 patients were included in the analysis. 92.7% of encounters resulted in at least 1 intervention, with 73.8% involving an education intervention. The average number of interventions per patient was 2.0, with 37.2% of encounters having multiple interventions. Conclusion: Implementation of a standardized telemedicine-based monitoring service allowed for pharmacist identification and management of issues related to DOAC therapy. These findings emphasize the importance of pharmacist-led interventions and telemedicine-based follow-up of DOAC therapy.