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Published on: January 18, 2018
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Optimization of DOAC management services in a centralized anticoagulation clinic
Katelyn W Sylvester1, Alisia Chen2, Andrea Lewin1
1Department of Pharmacy Services Brigham and Women's Hospital Boston Massachusetts USA.
Research and Practice in Thrombosis and Haemostasis
|May 11, 2022
Summary
The Brigham and Women's Hospital Anticoagulation Management Service (BWH AMS) enhanced its direct oral anticoagulant (DOAC) management, improving therapy quality and safety. Pharmacist-led care showed high satisfaction, though provider awareness needs improvement.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Health Services Research
Background:
- The Brigham and Women's Hospital Anticoagulation Management Service (BWH AMS) expanded direct oral anticoagulant (DOAC) services in 2017.
- The service has since refined its DOAC management plan and clinic workflow.
Purpose of the Study:
- To describe the evolution of DOAC management at BWH AMS.
- To detail key interventions implemented in DOAC care.
- To assess referring physicians' perspectives on centralized DOAC management by pharmacists.
Main Methods:
- Analysis of patients referred to BWH AMS and documented interventions.
- Survey distributed to 110 referring physicians regarding centralized DOAC management.
Main Results:
- Over 4 years, 1622 patients on DOACs were referred, with 3154 encounters.
- Significant interventions included medication procurement (212), dose adjustments (171), and procedure coordination (603).
- Physicians reported improved quality and safety but noted concerns about clinic awareness and potential duplication.
Conclusions:
- The BWH AMS DOAC clinic model is evolving to enhance clinical and operational value.
- Future improvements will focus on electronic tools and population management for DOAC therapy.
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