अमूर्त

Effect of telephone follow-up on the quality of patient compliance: practical experience: INR-PR monitoring by social messaging platforms in Morocco, study about 200 patients.

J.Nguadi-H, Elouartassi-H-Ziani-M.Bennani-N, Mouine-A, Bouzerda-J.Kheyi-H, Bouzelmate-N, Berrada-Z, Lakhal-A, Benyass-A.Chaib Mohammed V hospital- Rabat, Morocco

The Diagnosis Center of the Mohammed V Hospital of Rabat welcomes patients from different regions of Morocco. The long-distance travel, difficulty of access to care in rural Morocco, transportation problems, and delayed appointments all make follow-up of patients a very difficult task.

Materials and methods: This is a prospective, comparative analytic study of 200 patients under oral anticoagulant therapy based on vitamin K antagonists (VKA), followed in cardiology consultation, all of whom come from rural areas where access to care is difficult. These 200 patients were followed during 1 year in consultation, 100 of them (group 1) in standard consultation according to the appointments elaborated by the computerized system of the Diagnosis Center. The other 100 (group 2) were followed, moreover, by their doctor via telephone. One year later, the evaluation of the management quality was based on one-year INR assessments, presented complications, and patients' personal expenses.   Results: Patients of the 2nd group (group followed by telephone) were well ant coagulated most of the times with more frequent INR tests; 1305 INR performed by the 2nd group (1.09 per patient per month) compared with 500 INR by the 1st group (0.41 per patient per month). The number of complications was lower in the 2nd group as 5 patients presented a symptomatic overdose to anticoagulants and have evolved well, versus 12 for the 1st group, 4 of whom required hospitalization in the Intensive Care Unit for serious bleeding events, and one of them has deceased. Four patients in the first group had embolic events: 1 ischemic stroke with sequelae, 1 transient ischemic attack (TIA), and 2 prosthetic thromboses. Transportation expenses of the 2nd group were much smaller.   Conclusion: Telemedicine even by simple means has shown its potential contribution in terms of mortality and morbidity, in number of avoided hospitalizations with a great economic impact.