Medication therapy problems detected at community pharmacy INR checks.

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Medication Management

Background:

• Warfarin remains a common anticoagulant in Canada, traditionally managed via lab-based INR testing.
• The Community Pharmacy Anticoagulation Management Service (CPAMS) in Nova Scotia utilizes community pharmacists for point-of-care (POC) INR testing and warfarin management.
• This model offers opportunities to identify non-warfarin medication therapy problems (nwMTPs).

Purpose of the Study:

• To assess the rate and types of nwMTPs identified by pharmacists during POC INR testing in patients with atrial fibrillation.
• To evaluate the interventions made by pharmacists for these identified nwMTPs.

Main Methods:

• A prospective, multicentre, observational study was conducted across 40 community pharmacies in Nova Scotia.
• Pharmacists documented nwMTPs and interventions using the Qualtrics Insight Platform during routine POC INR visits.
• Data were collected over a 6-month period.

Main Results:

• Over 6 months, 43 nwMTPs were reported from 13 pharmacies.
• The estimated nwMTP detection rate was 1.26 per 100 POC INR tests (95% CI, 0.69 to 2.32).
• The most frequent category of nwMTPs was "Indication," often requiring additional therapy; pharmacists commonly recommended medication adjustments or patient education.

Conclusions:

• Pharmacists play a potentially significant role in detecting and managing various medication therapy problems during warfarin management.
• The high rate of indication-related problems suggests unmet therapeutic needs in patients on warfarin.
• Pharmacist-led POC INR testing in community settings can enhance comprehensive patient care by identifying and addressing nwMTPs.