Screening Tool to Reduce Anticoagulant Clinic Encounters

Area of Science:

• Pharmacology and Clinical Pharmacy
• Quality Improvement in Healthcare
• Cardiovascular Disease Management

Background:

• Anticoagulation Clinic management of warfarin and direct oral anticoagulants (DOACs) for atrial fibrillation stroke prevention.
• Clinical pharmacy specialists (CPS) manage patients on both warfarin and DOACs.
• A screening tool was developed to identify warfarin patients eligible for DOAC therapy switch.

Purpose of the Study:

• To evaluate the impact of a DOAC screening tool on monthly Anticoagulation Clinic encounters.
• To assess the effectiveness of a quality improvement initiative in managing anticoagulant therapy.

Main Methods:

• A quality improvement project studied clinic encounters for 3 months pre-screening and 2 months post-screening.
• The screening tool, based on VA Pharmacy Benefits Management guidance, identified eligible patients for DOAC switch.
• Patients were counseled on DOACs, and encounter data for all anticoagulant patients were recorded.

Main Results:

• Overall monthly encounters increased by 70 after screening tool implementation (P = .15).
• Thirty patients switched from warfarin to DOACs, resulting in 75 fewer encounters for this group (70.1% reduction, P = .01).

Conclusions:

• The DOAC screening tool did not reduce overall Anticoagulation Clinic encounters.
• Switching from warfarin to DOAC therapy significantly reduced patient encounters.
• Confounding factors may have influenced the study's overall findings.