Impact of a New Method of Warfarin Management on Patient Satisfaction, Time, and Cost

Abstract

STUDY OBJECTIVE: International normalized ratio self-testing with online remote monitoring and management (STORM₂) is an alternative to anticoagulation clinic management, but the patient's perspective of this method has not been evaluated in the United States; thus we sought to evaluate the impact of STORM₂ on patient satisfaction, time, and cost. DESIGN: Prospective pre- and postintervention study. SETTING: Freestanding clinical research center. PATIENTS: Forty-three patients treated with long-term warfarin therapy and monitored initially in the anticoagulation clinic setting and then with STORM₂, referred from 11 medical practices. INTERVENTION: Patients were asked to complete a survey and the Duke Anticoagulation Satisfaction Scale (DASS) before (at baseline) and after at least 3 months of STORM₂ (at follow-up). MEASUREMENTS AND MAIN RESULTS: Patient satisfaction and time were assessed by survey and the DASS. Costs were measured from the patient's perspective. Overall 90% of responders preferred STORM₂ to traditional clinic management. The DASS questions indicated that patients were more satisfied with their anticoagulation treatment and more likely to recommend oral anticoagulation to a friend after experiencing STORM₂. In addition, patients found STORM₂ to be less complicated and more convenient than traditional clinic management. For each traditional monthly visit, patients drove 20 miles and expended a total of 1.8 hours; using 55¢/mile for mileage reimbursement and $15/hour for lost wages, the cost for each visit was $38. The total cost for four STORM₂ visits per month was $10, for a net savings of $28 per patient per month. A total of 76% of patients were willing to pay additional money to eliminate a monthly clinic visit. CONCLUSION: STORM₂ is more convenient, less complicated, preferred by patients, and saves patients time and money compared with clinic management.