A retrospective assessment comparing pharmacist-managed anticoagulation clinic with physician management using international normalized ratio stability

Abstract

To assess the rates of therapeutic international normalized ratio (INR) levels between pharmacist-managed clinics compared to traditional physician-management and to determine the variation in rates of therapeutic INR levels between pharmacist-managed clinic data compared to physician-management. Retrospective, randomized, chart review. Referral only, outpatient, pharmacist based anticoagulation clinic under a community based tertiary care health system. Sixty-four patients with at least 1 year's worth of visits to the pharmacist managed clinic were reviewed for INR stability. The average percentage of visits within the defined therapeutic range, was 71.1% for the physician-managed group versus 81.1% for the pharmacist-managed group (P < 0.0001). The estimated variance in average therapeutic INR rates was double for the physician-managed group (365.7) versus the pharmacist-managed group (185.2) (P = 0.004). The pharmacist-managed anti-coagulation clinic had higher rates of INRs determined to be therapeutic and also exhibited significantly less variability in therapeutic INR rates relative to the physician-managed service.

Evaluation of pharmacist‐based compared to doctor‐based anticoagulation management in Qatar

“…The remaining studies that assessed the impact of pharmacist‐managed anticoagulation clinic were all observational in nature. Similar to our results, all these studies reported substantial improvement in the anticoagulation care in the pharmacist‐managed model in comparison to the usual care [14,15,17,18,21]. Two of these studies have also assessed efficacy and safety outcomes and showed lower rates of thromboembolic events, bleeding events and emergency department visits, all of which led to significant reductions in cost [17,21].…”

“…Many studies have indicated that specialized anticoagulation clinics can reduce complications associated with inappropriate warfarin use and improve its efficacy [13]. A pharmacist‐managed anticoagulation clinic represents a model that provides patients with more consistent management, closer monitoring, more education and awareness especially in regards to interacting drugs and food that can alter warfarin efficacy and safety [12,14–16]. Previous studies including observational and randomized controlled trials have compared anticoagulation management provided by pharmacist‐based anticoagulation clinics to the usual doctor care [14,15,17–22].…”

Quality of anticoagulation management with warfarin among outpatients in a tertiary hospital in Addis Ababa, Ethiopia: a retrospective cross-sectional study

“…Pharmacist managed anticoagulation clinics are becoming common in hospitals of most countries and have shown improved patient outcomes including reduced hospital admissions for preventable embolism, bleeding, or treatment of thrombosis [16, 25–27]. For example, implementation of a pharmacist managed ambulatory care anticoagulation clinic in South Korea resulted in an increase in percentage of INRs maintained within therapeutic range from 66% in the usual care group to 82% with the new initiative [28].…”

Pharmacoeconomic evaluation of providing pharmacist-managed anticoagulation service to patients on warfarin

“…Ovaj parametar je odabran kao mera ishoda zato što predstavlja osnovni indikator efektivnosti i bezbednosti terapije varfarinom [19], i u skladu je sa ostalim relevantnim studijama [3,5,8,20,21].…”