Cost-Effectiveness Study on Establishing a Warfarin Counseling Clinic for Egyptian Patients With Mitral Valve Prostheses
Condition: Cost Effectiveness
Study type: Interventional

Summary: 
      The outcome of poor adherence to medications can be life threatening with certain drugs like
      warfarin. For each 10% increase in non-adherence to warfarin, there was a 14% increase in the
      risk of under-anticoagulation with significantly higher rates of morbidity and mortality.
      Furthermore, warfarin therapy is fraught with several inherent problems. These include a wide
      variation in dose requirement, delayed onset of anticoagulant effect, prolonged continuation
      after cessation of therapy, serious interactions with a wide range of medications and food
      items, risk of major hemorrhage related to overdosing, unpredictable control in presence of
      co-morbidities such as hepatic and renal impairment.

      There is ongoing evidence that better outcomes are achieved when anticoagulation is managed
      by a pharmacist with expertise in anticoagulation management rather than usual care by
      physicians. Pharmacists can contribute to positive outcomes of therapy by educating and
      counseling patients to prepare and motivate them to follow their therapeutic regimens and
      monitoring plans, which will result substantially in improving the quality of care, reducing
      complications, and lowering hospitalization rates. Thus, beneficial effects of the
      pharmacist-managed counseling clinic have been repeatedly reported in terms of
      cost-effectiveness, patients' adherence to and knowledge about pharmacotherapy, and the
      outcome of treatment.

      The objective of this study is to evaluate the cost-effectiveness of establishing a
      Medication Counseling Clinic for outpatients with mitral valve prostheses taking warfarin
      therapy in an Egyptian Teaching Hospital setting. Availability of this information could be
      used to target further quality improvement efforts, which may significantly improve outcomes
      for patients and cost containment efforts in an era when cost-effectiveness is at the
      forefront of healthcare policy initiatives.
    


Intervention name(s): Education and counseling
Intervention type(s): Other
Intervention description(s): All patients or their caregivers will receive twenty minutes educational sessions for the first three visits according to patient ability to understand. At subsequent visits along the study duration, we will briefly review our educational material to refresh the patient's information. This will include: The objectives of treatment, disease progression process, risk factors, common symptoms of bleeding/thrombotic events and how to deal with this. Lifestyle modifications, including smoking cessation, blood pressure and diabetes control. Drug information: drug action, dose, indication, possible side effects, how to deal with the side effects, actions to take when missing the dose, storage conditions and when and how to administer. Possible interactions including drug-drug and drug-food interactions. Target INR and INR monitoring
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other