NUR 03.7 - Comparison of the Effectiveness, Safety and Cost of Tele-Consultation Versus Face-To-Face Model of Outpatient Anticoagulation Clinic Service

Background: During the COVID-19 pandemic, the need for social distancing and travel restrictions favoured the use of teleconsultations for medical appointments. However, there are limited studies evaluating the effectiveness, safety and cost of teleconsultation model of Anticoagulation clinic (ACC) in Singapore and globally.

Aims: This study is designed to compare the clinical, safety and cost of teleconsultation (TELE) versus face-to-face (F2F) model of outpatient ACC in a tertiary teaching hospital in Singapore. This is done by comparing the Time-in-Therapeutic Range (TTR), the incidence of (i) haemorrhagic events, (ii) thromboembolic events and (iii) warfarin-related hospitalisation or ED visits, and the mean direct cost per patient across the study period between the two modalities from a patient’s perspective.

Methods: This is a retrospective cohort study with a five-month ACC follow up either F2F or TELE modality. A total of 60 patients were recruited from Jan 2014 to Dec 2021 in the outpatient Cardiology, Neurology and General Medicine Pharmacist-run Anticoagulation Clinic. Differences in categorical data between groups were tested with Chi-square test. The independent sample student’s t-test was used to compare differences between group mean values. P-values were two-tailed, and values < 0.05 were considered statistically significant. Statistical analyses were performed using SPSS, v. 27.0.

Results: The TTR for F2F and TELE were not significantly different from each other (64.4% for F2F vs 58.3% for TELE, P=0.35). For safety outcomes, there were no significant difference in the major bleeding, CNRMB, other bleeding events, TE events, warfarin-related hospitalisation and ED visits. The mean direct patient cost for TELE over 5-months was significantly higher compared to F2F ($198.70 for TELE vs $130.80 for F2F, P < 0.01).

Conclusion(s): TELE ACC service was as effective and safe as F2F ACC service, but has significantly higher direct patient cost compared to F2F ACC service from a patient’s perspective.