Association between transportation barriers and anticoagulation control among an inner-city, low-income population: A prospective observational cohort study

Abstract

Background: Anticoagulation with warfarin represents a transportation-sensitive treatment state. Transportation barrier is a common reason for not using health care services. Objective: To assess the association between transportation barriers to anticoagulation clinic and anticoagulation control (AC) among an inner-city, low-income population. Patients/Methods: Adults expected to be on chronic warfarin therapy were recruited from an ambulatory anticoagulation clinic. Participants completed a validated questionnaire that assessed transportation barriers to clinic, defined as self-reported trouble getting transportation to a clinic and a composite score of the presence of transportation barriers. Suboptimal AC was defined as time in therapeutic range (TTR) <60% over 6 months. Prevalence ratios with 95% confidence intervals (CIs), adjusted for age, sex, and annual household income, described the association of transportation trouble and barriers with AC. Results: Of 133 participants, 42.9% had suboptimal AC. Mean age was 60.4 (SD, 13.6) years, and the majority of participants were women (62.2%). Participants with transportation trouble were more likely to report being disabled/unable to work (63.6%) and annual household income