Pharmacist-directed anticoagulation service improves warfarin care
MedWire News: Implementation of a pharmacist-directed anticoagulation service (PDAS) improves the transition of patients on warfarin from the inpatient to outpatient setting, US researchers report.
"The major advantage of this service was improvement in patient handoff, improved communication, and earlier patient follow-up after discharge," remark James Kalus and colleagues from the Henry Ford Hospital in Detroit, Michigan.
The researchers explain that anticoagulation with warfarin is complicated by inter-individual variability in response to therapy, drug interactions, a narrow therapeutic window, and also by communication issues during transition from the inpatient-to-outpatient setting.
In order to improve anticoagulation management and safety, the Henry Ford Hospital implemented an inpatient PDAS in which warfarin dosing, monitoring, patient education, and transition of care were coordinated by a specialized team of clinical pharmacists that worked in collaboration with physicians and outpatient anticoagulation clinic staff.
In the present study, the researchers assessed the impact of the PDAS on effective transition of care from the inpatient to outpatient setting among 500 patients receiving warfarin anticoagulation.
The patients were from two medical and two cardiology units that were randomly assigned to the PDAS (one of each unit) or to usual care (controls).
Full compliance with transition of care goals was defined as appropriate enrolment in the anticoagulation clinic, documented inpatient-to-outpatient provider contact prior to discharge, documented inpatient provider-to-anticoagulation clinic communication, and patient follow-up with the anticoagulation clinic within 5 days of discharge.
The researchers report, in The Journal of Hospital Medicine, that full compliance occurred in significantly more PDAS patients compared with controls at, 75.6% versus 2.8%.
In addition, significantly fewer PDAS patients required dosage adjustment at their first outpatient follow-up visit than did controls, at 44.8% versus 72.6%. There was also a trend for improved safety among the PDAS patients, with fewer experiencing the composite safety endpoint of thromboembolism, major bleeding, or an international normalized ratio of 5 or above than controls (10.0% vs 14.8%).
Kalus and co-authors say that the PDAS "was enthusiastically accepted by providers at our institution and expanded hospital-wide after completion of this pilot."
They conclude: "Implementation of a PDAS provides a net improvement in quality of care for the patient taking warfarin in the inpatient setting."
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By Laura Dean