Know Your PT/INR: Blood Thinner Awareness Initiative

BlueCross BlueShield of Florida

Blue Cross and Blue Shield of Florida recognized that thromboembolic disease is a significant cause of disability and death in the United States, resulting in approximately 300,000 hospitalizations and at least 50,000 deaths per year. It is estimated that direct care for thromboembolic disease costs the healthcare system $600 million annually.

BCBSFL was also aware that complications to therapy are common and therefore developed an education program that tackles the problem of venous thromboembolic disease (VTE) and the associated treatment – commonly anticoagulants, specifically warfarin. With warfarin treatment, patient compliance does not end with taking the medication: regular monitoring with laboratory tests is essential to confirm the optimal drug dose.

A 3-year retrospective analysis revealed that repeat embolic episodes occurred in 13.8 percent of plan members in treatment, indicating that medication levels may have been lower than optimal. Conversely, 5.8 percent of those in treatment experienced events of bleeding, a possible side effect of higher medication levels. Further review showed that members were in the optimal drug treatment levels only 37.7 percent of the time, despite being in treatment.

Program Elements

• An educational intervention was designed to improve health literacy regarding anti-coagulant safety.
  
  
• Monthly educational letters were sent containing key messages. Members in all lines of business prescribed an anticoagulant were included.
  
  
• The "Know Your PT/INR" initiative was designed to assess the impact of six monthly educational letters to members regarding their anticoagulant therapy.
  

Program Results

• Success of the program is measured by synthesizing responses to each letter, number of PT/INR tests per 30 day period, and time in optimal treatment range for members in the control or intervention groups.
  
  
• Over 95 percent of those returning a feedback card to the plan agreed that the information provided was helpful.
  
  
• Once follow-up data are complete, this program will also integrate cost and utilization data for a more complete view of the effectiveness of this simple and cost-effective program.
  

Contact

Lauren Hoffman, PharmD, 904-905-5952, lauren.hoffman@bcbsfl.com