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Stepwise approach to implementing ambulatory clinical pharmacy services
Kelly Epplen1, Michelle Dusing-Wiest, Joanna Freedlund
1Ambulatory Care Pharmacy Services, Health Alliance, Florence, KY 41042, USA.
Summary
Clinical pharmacists effectively managed anticoagulation services, leading to fewer thromboembolic events and minor bleeding. This approach provides a model for expanding medication therapy management services in integrated health systems.
Area of Science:
- Pharmacoeconomics
- Health Services Research
- Clinical Pharmacy
Background:
- Expansion of clinical pharmacist-managed services is crucial for integrated health networks.
- Anticoagulation management requires careful monitoring to prevent adverse events.
Purpose of the Study:
- To develop and implement a methodological approach for expanding clinical pharmacist-managed anticoagulation services.
- To establish a scalable model for ambulatory care pharmacy services within a health network.
Main Methods:
- A stepwise development and implementation strategy was employed.
- Services were established in both university and community hospital settings.
- Clinical pharmacists provided comprehensive anticoagulation management.
Main Results:
- Pharmacist-managed anticoagulation services were successfully implemented across two hospital settings.
- Significantly lower rates of thromboembolic events (p=0.005) and minor bleeding (p=0.038) were observed in the pharmacist-managed group.
- International Normalized Ratio values were within the therapeutic range approximately 75% of the time.
Conclusions:
- A stepwise approach facilitates the expansion of pharmacist-managed anticoagulation clinics within integrated health systems.
- This model can serve as a template for developing medication therapy management services.
- Clinical pharmacy services can improve patient outcomes in anticoagulation management.
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