Journal of the American College of Clinical Pharmacy : JACCP · 2026
Impact of Food and Travel Barriers on Warfarin Management: A Retrospective Cohort Analysis.
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Ayers Hannah, Thomas Karen C, Wilcox Lauren, Uppuluri Ellen M
Аннотация
BACKGROUND: Social determinants of health (SDOH) are the conditions in the environments which contribute to health, function, and quality of life risk factors and outcomes. Data regarding their integration in health care and role in clinical outcomes has been limited. Routine assessment of select SDOH was implemented in a pharmacist-run antithrombosis clinic at a mid-sized academic medical center with patients who endorsed specific barriers receiving applicable resources.
METHODS: This was a retrospective cohort study evaluating the association between patient-reported specific food and transportation SDOH barriers and their warfarin management. Adults with at least one in-person visit for warfarin management were eligible for inclusion. Patients reported the presence or absence of select SDOH barriers during their warfarin visit. The primary outcome was warfarin time in therapeutic range (TTR), compared between patient groups.
RESULTS: Of the 128 patients included, 42 endorsed a food and/or transportation barrier. The primary outcome, warfarin TTR, was significantly lower in patients who endorsed a food and/or transportation barrier, 42.6% versus 59.6% (p < 0.001). Similarly, patients who reported a SDOH barrier also had higher rates of appointment absence, 23.8% versus 11.8% (p < 0.001). Subgroups of patients reporting a food barrier only, transportation barrier only, or both barriers demonstrated consistent trends compared with patients reporting no SDOH barriers in both outcomes.
CONCLUSION: We identified two SDOH factors that affect relevant clinical outcomes for patients on a high-risk medication, warfarin, demonstrating the need for increased surveillance and attention for SDOH among this population. We also describe the implementation of SDOH screening within a pharmacist-managed anticoagulation clinic.
METHODS: This was a retrospective cohort study evaluating the association between patient-reported specific food and transportation SDOH barriers and their warfarin management. Adults with at least one in-person visit for warfarin management were eligible for inclusion. Patients reported the presence or absence of select SDOH barriers during their warfarin visit. The primary outcome was warfarin time in therapeutic range (TTR), compared between patient groups.
RESULTS: Of the 128 patients included, 42 endorsed a food and/or transportation barrier. The primary outcome, warfarin TTR, was significantly lower in patients who endorsed a food and/or transportation barrier, 42.6% versus 59.6% (p < 0.001). Similarly, patients who reported a SDOH barrier also had higher rates of appointment absence, 23.8% versus 11.8% (p < 0.001). Subgroups of patients reporting a food barrier only, transportation barrier only, or both barriers demonstrated consistent trends compared with patients reporting no SDOH barriers in both outcomes.
CONCLUSION: We identified two SDOH factors that affect relevant clinical outcomes for patients on a high-risk medication, warfarin, demonstrating the need for increased surveillance and attention for SDOH among this population. We also describe the implementation of SDOH screening within a pharmacist-managed anticoagulation clinic.