Stepwise approach to implementing ambulatory clinical pharmacy services.

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.