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.
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References
Francis C (2008) New issues in oral anticoagulants. Hematology 2008(1):259–265
Baetz B, Spinler S (2008) Dabigatran etexilate: an oral direct thrombin inhibitor for prophylaxis and treatment of thromboembolic diseases. Pharmacotherapy 80(11):1354–1373
Garcia D, Libby E, Crowther M (2010) The new oral anticoagulants. Blood 115(1):15–120
Bounameaux H (2009) The novel anticoagulants: entering a new era. Swiss Med Wkly 139(5–6):60–64
Bellamy L, Rosencher N, Eriksson BI (2009) Adherence to a new oral anticoagulant treatment prescription: dabigatran etexilate. Patient Prefer Adherence 3:173–177
Horton J, Bushwick B (1999) Warfarin therapy: evolving strategies in anticoagulation. Am Fam Physician 59(3):635–646
Chiquette E, Amato M, Bussey H (1998) Comparison of an anticoagulation clinic with usual medical care; anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 158:1641–1647
Preventing errors relating to commonly used anticoagulants. The Joint Commission; Sentinel Event Alert; c2008. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_41.htm. Accessed 21 Jan 2010
Lassen M, Laux V (2008) Emergence of new oral antithrombotics: a critical appraisal of their clinical potential. Vasc Health Risk Manag 4(6):1373–1386
Gandhi T, Shojania K, Bates D. Chapter 9. Protocols for high-risk drugs: reducing adverse drug events related to anticoagulants. AHRQ. http://archive.ahrq.gov/clinic/ptsafety/chap9.htm. Accessed 1 Jan 2010
George J, Popma J (2009) Reduced reimbursement for cardiovascular services by the centers for medicare and medicaid services. JACC: Cardiovasc Interv 2(9):894–896
Chamberlain M, Sageser N, Ruiz D (2001) Comparison of anticoagulation clinic patient outcomes with outcomes from traditional care in a family medicine clinic. JABFP 14(1):16–21
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Garton, L., Crosby, J.F. A retrospective assessment comparing pharmacist-managed anticoagulation clinic with physician management using international normalized ratio stability. J Thromb Thrombolysis 32, 426–430 (2011). https://doi.org/10.1007/s11239-011-0612-7
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DOI: https://doi.org/10.1007/s11239-011-0612-7