Quality of Pharmacist-Managed Anticoagulation Therapy in Long-Term Ambulatory Settings: A Systematic Review

Manzoor, Beenish S; Cheng, William C.; Lee, James C.; Uppuluri, Ellen M; Nutescu, Edith A.

doi:10.1177/1060028017721241

Cited by 62 publications

(67 citation statements)

References 47 publications

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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. 21 Our findings are also supported by previous studies which reported that anticoagulation management services improve the quality of care provided to patients, 8 and that pharmacist-specific models of anticoagulation service result in better patient outcomes compared with routine medical care. 6,9,13,16,[21][22][23][24][25] An acknowledged limitation of our study, however, is that with the nature of a retrospective observational cohort study, we were not able to randomly assign patients to PMAC or NMAC groups.…”

Section: Discussionsupporting

confidence: 86%

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: 86%

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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“…Our patient cohort had a slightly lower TTR (63% vs 67%) than that reported in a recent NZ study in which patients were managed by their general practitioner using decision‐support software . More significantly, where this software has been combined with pharmacist‐led warfarin management in NZ and elsewhere, this has led to higher TTR (>70%) than in those patients managed by general practitioners . Although confounders may account for some of these discrepancies, the higher TTR probably reflect better adherence to decision‐support recommendations .…”

Section: Discussioncontrasting

confidence: 62%

“…2 More significantly, where this software has been combined with pharmacist-led warfarin management in NZ and elsewhere, this has led to higher TTR (>70%) than in those patients managed by general practitioners. 17 Although confounders may account for some of these discrepancies, the higher TTR probably reflect better adherence to decision-support recommendations. 2 These studies suggest that anticoagulant control in our regions could be improved by improving education for general practitioners, widening access to decisionmanagement software, and encouraging pharmacist-led monitoring.…”

Section: Inr Monitoring In Auckland and Northlandmentioning

confidence: 99%

International normalised ratio monitoring in the community populations of the Auckland and Northland regions of New Zealand: time in therapeutic range and frequency of testing

McAuliffe¹,

Silva²,

Upton³

et al. 2018

Internal Medicine Journal

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“…The impact of outpatient clinical pharmacy services has been well supported throughout a variety of disease states including asthma, anticoagulation, pain, heart failure, geriatrics, diabetes, and smoking cessation. Pharmacists in these settings have shown improvements in adherence, better management of adverse effects, and overall cost reduction …”

Section: Introductionmentioning

confidence: 99%

Impact of pharmacy services on cystic fibrosis transmembrane conductance regulator modulator prescribing at a pediatric cystic fibrosis center

Wright

Singh

Schultz

et al. 2019

Pediatric Pulmonology

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Background This study was undertaken to determine if the presence of a clinical pharmacy team impacted patients’ access to cystic fibrosis transmembrane conductance regulator (CFTR) modulators. Methods A retrospective chart review of electronic medical records from the University of Iowa Hospitals and Clinics (UIHC) was conducted. Data were collected regarding the timing of prior authorization (PA) submissions and approvals from 2012 to 2018. The Wilcoxon rank‐sum test was used to compare the meantime (days) between prescription and PA submission dates, and PA submission and approval date for all patients included in the analysis. Comparisons were made for pre‐ and postpharmacy services eras as well as the UIHC Specialty Pharmacy versus a non‐UIHC Specialty Pharmacy. Results Sixty‐three patients were included in the final analysis. The average time between prescription date and PA submission was 12.5 days (standard deviation [SD] = 17.4 days) in the preclinical pharmacy services era and 3.5 days (SD = 5.8 days; P = .028) in the postclinical pharmacy services era. The average time to PA submission significantly decreased from 9.8 days (SD = 13.1 days) to 1.3 days (SD = 4.2 days; P < .0001) when prescriptions were filled by the UIHC Specialty Pharmacy vs a non‐UIHC Specialty Pharmacy. Conclusions There was a significant benefit to CFTR modulator prescribing when clinical pharmacy services were incorporated in our cystic fibrosis (CF) care team, which will become increasingly important with the anticipation of new CF medications in the near future.

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Quality of Pharmacist-Managed Anticoagulation Therapy in Long-Term Ambulatory Settings: A Systematic Review

Abstract: Compared with routine care, pharmacist-managed outpatient-based anticoagulation services attained better quality of anticoagulation control, lower bleeding and thromboembolic events, and resulted in lower health care utilization.

Cited by 62 publications

References 47 publications

Outcomes of systematic anticoagulation management in pharmacist and nurse specialized clinics

Outcomes of systematic anticoagulation management in pharmacist and nurse specialized clinics

International normalised ratio monitoring in the community populations of the Auckland and Northland regions of New Zealand: time in therapeutic range and frequency of testing

Impact of pharmacy services on cystic fibrosis transmembrane conductance regulator modulator prescribing at a pediatric cystic fibrosis center

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