Outcome analysis of a pharmacist-managed anticoagulation service

Area of Science:

• Pharmacology
• Health Services Research
• Clinical Pharmacy

Background:

• Warfarin therapy requires diligent monitoring to prevent thromboembolic disorders.
• Traditional anticoagulation management in family practice may have suboptimal outcomes.
• Pharmacist-led services can potentially enhance patient care and cost-effectiveness.

Purpose of the Study:

• To evaluate the effectiveness of a pharmacist-managed anticoagulation monitoring service (AMS) for warfarin patients.
• To determine the cost-effectiveness of AMS in a family practice setting.
• To compare patient outcomes between AMS and physician-only monitoring.

Main Methods:

• Retrospective chart review of warfarin patients at a family practice residency program.
• Comparison of outcomes between patients managed by AMS and a control group managed by physicians.
• Analysis of thromboembolic events, hemorrhagic events, unplanned visits, and hospital admissions.
• Cost analysis including hospitalizations, ER visits, and AMS participation.

Main Results:

• The AMS group experienced significantly fewer adverse events (rate ratio 20) compared to the control group.
• Control group: 12 thromboembolic and 7 hemorrhagic events in 28 person-years.
• AMS group: 2 minor hemorrhagic events in 60 person-years.
• Significant cost savings were projected with pharmacist-managed AMS, with potential avoidance of $4072.68 per person-year.

Conclusions:

• Pharmacist-managed AMS improves outcomes for patients on warfarin in family practice.
• The service is a cost-effective approach to managing anticoagulation.
• Implementing AMS can lead to better patient safety and reduced healthcare expenditures.