Is long-term pharmacist-managed anticoagulation service efficient? A pragmatic randomized controlled trial

Area of Science:

• Pharmacology and Pharmaceutical Sciences
• Health Services Research
• Internal Medicine

Background:

• Pharmacist-managed anticoagulation services (PMAS) offer initial follow-up for oral anticoagulant patients.
• Transferring stabilized patients to physician care may be a cost-effective alternative to long-term PMAS.

Purpose of the Study:

• To compare the effectiveness and cost of long-term PMAS follow-up versus physician follow-up for stabilized oral anticoagulant patients.

Main Methods:

• Patients stabilized in PMAS were randomized to physician or continued PMAS care.
• Evaluated outcomes included INR control, complication rates, quality of life, healthcare service use, and costs.

Main Results:

• Both groups achieved similar international normalized ratio (INR) control (77.3% vs 76.7% in-range).
• No significant differences in complications or quality of life were observed.
• Long-term PMAS follow-up incurred an incremental cost of CAN$123.80 per patient year.

Conclusions:

• Excellent INR control is achievable with either continued PMAS or physician follow-up for stabilized patients.
• Long-term PMAS follow-up may represent a higher cost without additional clinical benefit.