Conclusions: This connectivity helps the patient and provider
to overcome obstacles in healthcare. Geographic, financial, and
time constraints are just a few obstacles as well as lessening
the added stress of travel and missing work for the patient. The
healthcare provider is offered added support as well from a
highly trained specialist that they may not be able to access in
the smaller rural setting. An extra set of eyes and ears is on the
scene to assess and consult within real time situations.
21) Comparison of Pharmacist Managed
In-Person and Telehealth Warfarin
Clinic Outcomes
Michael Pham, PharmD and Laura Moore, PharmD
North Country HealthCare
Background: Warfarin is an oral anticoagulant used for
the prevention of thromboembolism and requires frequent
monitoring due to a narrow therapeutic window. The use of
warfarin in rural communities has been complicated by a lack of
access to consistent and timely monitoring. Through telehealth
anticoagulation appointments, patients from rural communities
are able to have more frequent monitoring by pharmacists.
Methods: The electronic medical records (EMR) of patients on
warfarin enrolled at the NCHC on-site anticoagulation clinic in
Flagstaff, AZ was compared to the EMRs of pharmacist managed
telehealth patients on warfarin at NCHC satellite clinics. The
primary outcome measured the time-in-therapeutic-range (TTR)
using the Rosendaal method. The secondary outcome compared
the TTR of physician-managed pa tients at NCHC Williams
satellite clinic versus TTR of pharmacists managed telehealth
patients at NCHC Williams satellite clinic.
Results: The average TTR for patients managed by pharmacist
in-person at Flagstaff was 70.55% (N=82) while the average
TTR for patients managed by pharmacist through telehealth
was 58.98% (N=35, Williams), 63.04% (N=4, Winslow), 63.09%
(N=6, Ashfork), and 50.60% (N=7, Seligman). Patients who
were managed by their providers had an average TTR of 51.99%
(N=27, Williams). Patients who were seen in-person (Flagstaff)
had a statistically significant higher time in therapeutic
range than patients who were seen through telehealth at
the Williams clinic (p-value 0.0091). However, there was no
statistically significant difference of TTR seen between in-
person appointments (Flagstaff) with telehealth patients from
other clinics. There was also no significant difference between
TTR of physician managed patients compared with pharmacist
managed telehealth patients at the Williams clinic.
Conclusions: Patients who were managed in-person by a
pharmacist had a higher TTR than patients who were managed
by pharmacist through telehealth. Also patients managed by
pharmacists via Telehealth at Flagstaff, Williams, Winslow, and
Ashfork had a higher average TTR than patients managed in
person by their providers.
46 | Telemedicine Telehealth Service Provider Summit
22) Optimizing Behavioral Health
Services in Long-Term Care with Scalable
Telemedicine
Christopher Pick
Deer Oaks – a behavioral health company
Specialty medical services can be challenging to deliver in
institutional settings. A study in the American Journal of Preventive
Medicine finds that a majority of non-metropolitan counties (65%)
do not have a psychiatrist and almost half of non-metropolitan
counties (47%) do not have a psychologist. Based on current
CDC statistics for nursing home residents, over two-thirds
suffer from behavioral and mental health disorders, 37% suffer
from depression which can lead to suicide, and over 50% from
Alzheimer’s or other dementias. Behavioral health conditions
influence many comorbid conditions, immune and cardiac
functions, susceptibility to infection, asthma and recovery time.
Integrated, or partial behavioral health services for residents are
scarce with more than 30% of nursing homes in non-metropolitan
areas. As the nation’s leading provider of behavioral health
services to long-term care communities, Deer Oaks serves over
1,400 long term care facilities across 27 states, serving over
10,000 senior adults. Known for consistency, clinical efficacy and
Sponsor