Outcomes of systematic anticoagulation management in pharmacist and nurse specialized clinics. Issue 2 (15th December 2018)

• Record Type: Journal Article
• Authors: Manzoor, Beenish S.; Bauman, Jerry; Shapiro, Nancy L.; Stamos, Thomas; Galanter, William; Nutescu, Edith A.
• Is Part Of: Journal of the American College of Clinical Pharmacy. Volume 1:Issue 2(2018)
• Page Start: 68
• Page End: 73
• Publication Date: 2018-12-15
• Subjects: anticoagulation -- anticoaguloation clinic -- nurse -- pharmacist -- systematic care -- warfarin; Pharmacy -- Periodicals; Pharmacy Service, Hospital; Periodicals; Electronic journals; Periodical; 615.105
• DOI: 10.1002/jac5.1051
• Languages: English
• ISSNs: 2574-9870

Abstract

Abstract : Background: While systematic anticoagulation management leads to improved outcomes, there is limited data comparing outcomes in anticoagulation clinics managed by pharmacists vs nurses. The objective of this study was to evaluate the effect of pharmacist vs nurse‐managed clinics on the quality of anticoagulation and warfarin‐related hospitalizations and emergency department (ED) admissions. Methods: A retrospective observational cohort study of patients treated with warfarin and referred to a pharmacist‐managed anticoagulation clinic (PMAC) or a nurse‐managed anticoagulation clinic (NMAC) was conducted at the University of Illinois Hospital and Health Sciences System. The primary outcome was the proportion of international normalized ratio levels in therapeutic range (PIR). The secondary outcome was warfarin‐related hospitalizations and ED visits. Multivariate regression models were used to evaluate the effect of the model of care (PMAC vs NMAC) on PIR and hospitalization/ED visits, respectively. An economic evaluation of adverse events was also undertaken. Results: A total of 200 consecutive patients (100 patients in the PMAC group and 100 patients in the NMAC group) were included. The majority of patients were females (58.5%) and average age was 61.4 ± 14.6 years. Patients in the PMAC group were more nonadherent to warfarin therapy and had more than three missed clinic appointments compared with the NMAC group ([19.1% ± 10.1% vs 4.1% ± 4.1%, P < 0.05]; and [78% vs 33%, P < 0.05]) respectively. The average PIR was 51.8% ± 15.9% and 56.2% ± 13.9% ( P = 0.04) in the PMAC and NMAC groups, respectively. After controlling for confounders, the adjusted PIR was not different between the two groups. The NMAC group, however, had over seven times greater odds of hospitalization/ED visits compared to the PMAC group. The PMAC saved $505 349 over a 1.25 year period. Conclusion: The quality of warfarin anticoagulation did not differ between pharmacist and nurse‐managed models of anticoagulation care, however, PMACs decreased the odds of warfarin‐related hospitalizations/ED visits and their associated costs.