Establishing community pharmacy-based anticoagulation education and monitoring programs

To determine the process for establishing community pharmacy-based anticoagulation education and monitoring programs using fingerstick capillary whole blood testing.

Pilot community-based intervention study using convenience sample of patients.

Three community pharmacies with pre-established health education centers and laboratories certified for moderate complexity.

26 patients were referred to the clinics by 2 primary care physicians for each pharmacy, most with a diagnosis of atrial fibrillation.

Patient assessment, including adherence to prescribed regimens; changes in medication use, including prescription and nonprescription medications, vitamins, health foods, and nutrition supplements; changes in diet and ethanol consumption; assessment of adverse experiences; and needed changes in warfarin dosage.

Percentage of international normalized ratio (INR) values within therapeutic range, major bleeding events, and thrombotic events.

A total of 21 patient charts were available for analysis. More than 80% of patients had INR values within their targeted range (+/- 0.2) 60% or more of the time, comparable with values reported for anticoagulation clinics. Of the 235 INR values obtained during the study, 75% were within the individualized targeted therapeutic range (e.g., 2 to 3 +/- 0.2). One patient experienced a major bleeding event related to an underlying cancer. None of the patients experienced a thrombotic event.

Community pharmacies can effectively implement an anticoagulation education and monitoring program.