Compare the clinical management of warfarin among physician versus pharmacist-led coagulation clinic: structured systematic review

Abstract

The aim of the study was to assess the management of INR therapeutic range as an estimate for achieving therapeutic outcome and estimate sub/supra-therapeutic INR's among physician versus pharmacist-led clinics. Articles were searched in: PubMed, Cochrane, Springer, Science Direct, and Wiley. The search was limited to the English language from 2010 to 2016. The inclusion criteria of the articles keywords such as warfarin, management, pharmacist, physician, therapy, clinic, and anticoagulation were used and GRACE guideline was used to assess the quality of these research articles. A total of 1050 articles were found with the relative subject, after excluding the duplicates more than 50% have been excluded, following the title and reviewing the abstract another 133 (12.67%) were ruled out, and 6 studies were included in the systematic review. In multiple studies pharmacist-Led coagulant clinic showed better outcomes with warfarin anticoagulant therapy. Patients exhibits high satisfaction levels and least warfarin induced complications in comparison with those results obtained with physician-led clinic. It is found that patients-oriented care has not been reported in the retrieved literature, which might open a room for researcher to determine the impact of services provided by pharmacists on individual patient-centered outcomes.

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“…Elewa et al and Gillani et al suggested pharmacists' involvement may improve the outcomes of pharmacotherapy of anticoagulants, but a systematic review by Brown et al made a contrary conclusion in depression management. 53 , 54 , 55 It is suggested that pharmacists may exert more influence in mental health care to achieve a better quality of pharmacotherapy. Effective approaches include detecting early-stage mental health illnesses, collaborative work with multidisciplinary teams and taking active interventions to improve adherence.…”

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“…3 Considered to be "cutting edge" as recently as the 1990s, 4,5 pharmacist-run warfarin clinics and focused acute care services have been shown to provide superior international normalized ratio management and to improve patient outcomes. 6,7 Pharmacist expertise in anticoagulation management has likewise continued to evolve in the acute care setting, with pharmacists involved in early programs effectively managing both oral and injectable anticoagulants and improving the safety and quality of patient care. 8,9 Despite early evidence of their value, high-quality anticoagulation management programs did not become a standard in all health care institutions across the United States, which has allowed medication errors and preventable adverse events to occur at unacceptably high rates.…”

“…Considered to be “cutting edge” as recently as the 1990s, 4,5 pharmacist‐run warfarin clinics and focused acute care services have been shown to provide superior international normalized ratio management and to improve patient outcomes 6,7 . Pharmacist expertise in anticoagulation management has likewise continued to evolve in the acute care setting, with pharmacists involved in early programs effectively managing both oral and injectable anticoagulants and improving the safety and quality of patient care 8,9 …”