Related Experiment Videos
Comparative effectiveness of general practitioner versus pharmacist dosing of patients requiring anticoagulation in
1Anticoagulant Services Manager, Gateshead Health NHS Trust, Queen Elizabeth Hospital, Gateshead, UK. jill.holden@tinyonline.co.uk
Insights
Pharmacist-managed anticoagulation showed improved international normalized ratio (INR) control compared to general practitioner (GP) management. Pharmacists achieved a higher proportion of INR results within the therapeutic range and longer intervals between tests, indicating enhanced patient care.
Area of Science:
- Pharmacology
- Internal Medicine
- Community Pharmacy Practice
Background:
- Anticoagulation management is crucial for preventing thromboembolic events.
- General practitioners (GPs) traditionally manage anticoagulation in the community.
- Pharmacist-led services offer a potential alternative for anticoagulation management.
Purpose of the Study:
- To compare the effectiveness of anticoagulation management by pharmacists versus GPs.
- To evaluate international normalized ratio (INR) control and monitoring intervals in both management models.
Main Methods:
- Retrospective analysis of 1782 INR results from 51 patients managed by both GPs and pharmacists.
- Comparison of the proportion of INR results within the therapeutic range.
- Analysis of the mean interval between INR tests for both management groups.
Main Results:
- Pharmacist management resulted in a significantly higher proportion of INR values within the therapeutic range (0.7 vs. 0.6, P = 0.03).
- The mean interval between INR tests was significantly longer under pharmacist management (34.1 days vs. 28.6 days, P = 0.01).
- Pharmacist management demonstrated a superior weighted INR index compared to GP management (24.7 vs. 17.2, P < 0.001).
Conclusions:
- Pharmacist management of anticoagulation is non-inferior to GP management.
- Pharmacists achieve better INR control with less frequent monitoring.
- This study supports the expanded role of pharmacists in community-based anticoagulation services.
Objective:
To compare pharmacist- with general practitioner-managed anticoagulation in the community.
Design:
Included in the study were all patients who had been managed by general practitioners (GPs) and subsequently referred to the pharmacist-led outreach service within Gateshead & South Tyneside Health Authority. A retrospective analysis was carried out recording individual international normalized ratio (INR) estimations, the time interval between successive tests and whether the result resided within the prescribed therapeutic range. These values were derived for both the GP- and pharmacist-managed elements of care.
Subjects:
Fifty-one patients who met the inclusion criteria identified from eight practices had been successively treated by GPs and then by pharmacists. Eighteen patients (35.3%) had a diagnosis of non-rheumatic atrial fibrillation, 10 (19.6%) had thromboembolic disease and 13 (25.5%) had valvular disease.
Results:
In total, 1782 INR results were analysed. GPs were responsible for 1075 (60.3%) of these estimations and pharmacists for the remaining 707 (39.7%). Of the GP-monitored results the patient-mean proportion of estimates that resided within the prescribed therapeutic range was 0.6 (SD = 0. 21, n = 51) compared with pharmacist management where patients showed a mean in range proportion of 0.7 (SD = 0.18, n = 51, P = 0. 03). The mean inter-test interval was 28.6 days (SD = 8.65, n = 51) for GPs compared with 34.1 days (SD = 12.3, n = 51, P = 0.01) for pharmacists. The weighted INR index for GPs was 17.2 (SD = 7.93, n = 51) compared with 24.7 (SD = 13.15, n = 51, P < 0.001) for pharmacists.
Conclusion:
There is no apparent detriment to INR control when pharmacist management is compared with that of GPs. The overall proportion of INR estimations within the prescribed range is greater for pharmacists than for GPs and the interval between tests is longer for pharmacists compared with GPs.