Anticoagulation Management Services: Entering a New Era

Nutescu, Edith A.

doi:10.1592/phco.30.4.327

Cited by 19 publications

(30 citation statements)

References 13 publications

(33 reference statements)

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“…Adhering to this higher threshold of quality in anticoagulation therapy management may be possible due to the skills and specialized training of pharmacists in anticoagulation therapy . Our findings are also supported by previous studies which reported that anticoagulation management services improve the quality of care provided to patients, and that pharmacist‐specific models of anticoagulation service result in better patient outcomes compared with routine medical care …”

Section: Discussionsupporting

confidence: 85%

Outcomes of systematic anticoagulation management in pharmacist and nurse specialized clinics

Manzoor

Bauman

Shapiro

et al. 2018

J Am Coll Clin Pharm

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Background While systematic anticoagulation management leads to improved outcomes, there is limited data comparing outcomes in anticoagulation clinics managed by pharmacists vs nurses. The objective of this study was to evaluate the effect of pharmacist vs nurse‐managed clinics on the quality of anticoagulation and warfarin‐related hospitalizations and emergency department (ED) admissions. Methods A retrospective observational cohort study of patients treated with warfarin and referred to a pharmacist‐managed anticoagulation clinic (PMAC) or a nurse‐managed anticoagulation clinic (NMAC) was conducted at the University of Illinois Hospital and Health Sciences System. The primary outcome was the proportion of international normalized ratio levels in therapeutic range (PIR). The secondary outcome was warfarin‐related hospitalizations and ED visits. Multivariate regression models were used to evaluate the effect of the model of care (PMAC vs NMAC) on PIR and hospitalization/ED visits, respectively. An economic evaluation of adverse events was also undertaken. Results A total of 200 consecutive patients (100 patients in the PMAC group and 100 patients in the NMAC group) were included. The majority of patients were females (58.5%) and average age was 61.4 ± 14.6 years. Patients in the PMAC group were more nonadherent to warfarin therapy and had more than three missed clinic appointments compared with the NMAC group ([19.1% ± 10.1% vs 4.1% ± 4.1%, P < 0.05]; and [78% vs 33%, P < 0.05]) respectively. The average PIR was 51.8% ± 15.9% and 56.2% ± 13.9% (P = 0.04) in the PMAC and NMAC groups, respectively. After controlling for confounders, the adjusted PIR was not different between the two groups. The NMAC group, however, had over seven times greater odds of hospitalization/ED visits compared to the PMAC group. The PMAC saved $505 349 over a 1.25 year period. Conclusion The quality of warfarin anticoagulation did not differ between pharmacist and nurse‐managed models of anticoagulation care, however, PMACs decreased the odds of warfarin‐related hospitalizations/ED visits and their associated costs.

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Section: Discussionsupporting

confidence: 85%

Outcomes of systematic anticoagulation management in pharmacist and nurse specialized clinics

Manzoor

Bauman

Shapiro

et al. 2018

J Am Coll Clin Pharm

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“…2,3 As health systems increase their focus on medication safety, the pharmacist's role in anticoagulation management is expected to expand. 4 Numerous quality, regulatory, and reimbursement organizations have brought attention to the appropriate preventative and therapeutic use of antithrombotic therapy in the health care setting. The goal of reducing harm with anticoagulant medications was recently added to the list of Joint Commission National Patient Safety Goals.…”

Section: Introductionmentioning

confidence: 99%

“…In the future, pharmacists will manage and monitor patients with a broad range of thrombotic disorders who are on a variety of antithrombotic medications. 4 Pharmacy education will play a central role in equipping pharmacy graduates with an appropriate foundation for future practice in this setting.…”

Section: Introductionmentioning

confidence: 99%

An Innovative Elective Course in Anticoagulation Management

Garwood¹,

Bishja²,

Smythe

2010

American Journal of Pharmaceutical Education

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Objective. To develop and implement an elective pharmacy course in anticoagulation management and assess student learning. Design. Students participated in active-learning activities including evaluating a patient receiving outpatient or inpatient anticoagulation therapy, participating in a team project and presentation, and completing a ''living with anticoagulation'' assignment that included modeling both the health care provider's and the patient's role. Assessment. A precourse and postcourse standardized examination on anticoagulation along with a short answer midterm and final examination were administered. Performance between precourse and postcourse examination improved by approximately 25%, and 90% of students scored $ 90% on the final examination. Reflective narratives provided support that students found the ''living with anticoagulation'' assignment a valuable learning experience which developed empathy towards patients.Conclusion. An elective course in anticoagulation management that included multiple active-learning assignments was successful in increasing both students' knowledge and empathy.

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“…Over the last three decades, a host of structured models of oral anticoagulation management has evolved. There are an estimated 3000 anticoagulation management services (AMS) in existence in the United States, providing care to approximately 30% to 40% of the patients receiving oral anticoagulation therapy . Historically, most anticoagulation clinics have focused on management of warfarin therapy alone.…”

mentioning

confidence: 99%

The future of anticoagulation management services: Ensuring and expanding patient access to pharmacists' care

Garwood

2018

J Am Coll Clin Pharm

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Anticoagulation Management Services: Entering a New Era

Cited by 19 publications

References 13 publications

Outcomes of systematic anticoagulation management in pharmacist and nurse specialized clinics

Outcomes of systematic anticoagulation management in pharmacist and nurse specialized clinics

An Innovative Elective Course in Anticoagulation Management

The future of anticoagulation management services: Ensuring and expanding patient access to pharmacists' care

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