Challenges of Anticoagulation Management Service and Need of Establishing Pharmacist-Led Anticoagulation Clinic in Tertiary Care Teaching Hospital, Ethiopia: A Qualitative Study

Abstract

Pupose To explore the challenges of anticoagulation management (AMS) and assess the need for establishing a pharmacist-led anticoagulation clinic (PLAC) at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. Methods We conducted a qualitative study at TASH. Using a semistructured interview guide, we interviewed 15 physicians from different specialties, heads of pharmacy and laboratory departments. We also included 20 patients to explore their general perceptions, and experiences with and challenges of AMS; and the need to implement PLAC in the hospital. Results Only three physicians responded that they had protocols for initiating and maintaining warfarin dosing. Having protocols for venous thromboembolism (VTE) risk assessment, VTE prophylaxis and treatment, bleeding risk assessment, and contraindication to anticoagulant therapy were reported by seven, six, four, and three participants, respectively. Lack of trained healthcare professionals and a separate AMS clinic, inconsistency in INR testing and anticoagulant availability, and longer appointment times were the biggest challenges of the existing AMS, according to 80% of respondents. Fourteen patient respondents indicated that their satisfaction with the AMS was affected by long wait times and inconsistent availability of anticoagulants and INR testing. The head of the laboratory stated that the facilities for INR testing are inadequate and affect the quality of AMS and customer satisfaction, and supplemented by the head of the pharmacy by adding irregularities of supplies and inadequate counseling on anticoagulants. Respondents suggested that there is a need to establish a PLAC with well-adopted standard operating procedures, qualified manpower, adequate training of assigned staff, and sustained supply of anticoagulants and INR testing. Conclusion The hospital’s AMS is not optimal to provide adequate services during the study period. Based on these findings and recommendations, the supporting literature, and the experiences of other facilities, the PLAC was established in TASH.

Comparison of anticoagulation control and outcomes between usual medical care and pharmacist-led anticoagulation service in ambulatory patients taking warfarin at tertiary hospital in Ethiopia: a quasi-experimental study

“…Given the practical limitations and complex nature of effective anticoagulant delivery, the adoption of such practices might improve the treatment response and patient outcomes in resource-constrained settings. Based on evidence reported elsewhere regarding the importance of PLAS in improving the quality of anticoagulation in patients receiving warfarin [ 42 , 47 , 48 , 50 – 52 ] and needs assessment study recommendations in the same hospital [ 53 ], the first pharmacist-led anticoagulation clinic (PLAC) in Ethiopia was established at the Tikur Anbessa Specialized Hospital (TASH) in April 2018 under the cardiac clinic. The novelty of our study lies in the distinctive healthcare context of Ethiopia, which requires specific intervention strategies tailored to resource-constrained environments, culturally diverse settings, lower health literacy levels, limited diagnostic tools, underdeveloped electronic health records, and a shortage of well-trained healthcare providers.…”

Practices, beliefs, and attitudes of clinicians in prescribing direct oral anticoagulants for obese adults with atrial fibrillation: a qualitative study

“…In acute care facilities where demand is high, the urgency of cases clinicians need to treat perpetually limits time. Referral to outpatient services (e.g., anticoagulation clinics, home medicine review), and follow-up appointments in primary care to ensure appropriate and adequate treatment are proposed solutions [37][38][39] but these findings support the notion that geographical access challenges in Australia are a longstanding issue, evidenced by poorer health outcomes in rural versus metropolitan regions [40]. Specialist referral rates are significantly lower in "very remote" compared to "major city" (22 versus 143 per 100,000 population) areas.…”