Effect of a Centralized Clinical Pharmacy Anticoagulation Service on the Outcomes of Anticoagulation Therapy

Witt, Daniel M.; Sadler, Melanie A.; Shanahan, Roberta L.; Mazzoli, Georgann; Tillman, Donald J.

doi:10.1378/chest.127.5.1515

Cited by 303 publications

(308 citation statements)

References 13 publications

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“…The clinic's proportion of INR values in therapeutic range for the past year was 66%, which is consistent with published standards. 42,43 By continuing to refer patients to the partnership programs, physicians have demonstrated an ongoing acceptance and support of the programs and, by implication, that the programs are helping patients to achieve improved health outcomes.…”

Section: Discussionmentioning

confidence: 99%

A Strategy to Develop Advanced Pharmacy Practice Experiences

Turner¹,

Ellis²,

Giles³

et al. 2007

Am J Pharm Educ

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Objective. To establish statewide medication, disease management, and other clinical programs to serve as advanced pharmacy practice experience (APPE) training sites for the University of Colorado at Denver and Health Sciences Center School of Pharmacy, and to guarantee year-round support for the programs by providing pharmacy students with the necessary competencies to carry a significant proportion of each program's workload. Methods. Partnerships with pharmacies willing to use students to expand their scope of clinical practice or support existing programs were established. Partners were asked to choose the clinical program(s) they wished implemented or supported and were guaranteed that APPE students would contribute to carrying each program's clinical service workload for 48 week/year under the supervision of the partners' pharmacists. In addition, partners implementing new programs were offered other support, including equipment, supplies, and training and mentoring for their pharmacists. Evaluation. Twenty-two partnerships involving anticoagulation, diabetes, immunization, medication reconciliation, and other clinical programs were established with hospital, community, and community health center pharmacies. The partnerships provided 213 APPE placements in the 2006-2007 academic year. Conclusion. This work demonstrates that by using innovative approaches, a pharmacy school can form new partnerships with hospital, community health center, and community pharmacies, as well as work with existing clinical programs, to create a variety of medication, disease management, and other APPEs to meet its increasing placement needs and evolving accreditation standards.

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Section: Discussionmentioning

confidence: 99%

A Strategy to Develop Advanced Pharmacy Practice Experiences

Turner¹,

Ellis²,

Giles³

et al. 2007

Am J Pharm Educ

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“…Patients whose warfarin administration is monitored at anticoagulation clinics have lower rates of adverse events and a higher proportion of time with anticoagulation in range [12,69]. Home INR monitoring can also be beneficial [25], but requires self-administered fingersticks and careful education and self-management of dosing [27].…”

Section: Methods To Try To Improve Warfarin Therapymentioning

confidence: 99%

Warfarin therapy: in need of improvement after all these years

Kimmel

2008

Expert Opinion on Pharmacotherapy

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Background-Warfarin therapy has been used clinically for over 60 years, yet continues to be problematic because of its narrow therapeutic index and large inter-individual variability in patient response. As a result, warfarin is a leading cause of serious medication-related adverse events, and its efficacy is also suboptimal.Objective-To review factors that are responsible for variable response to warfarin, including clinical, environmental, and genetic factors, and to explore some possible approaches to improving warfarin therapy.Results-Recent efforts have focused on developing dosing algorithms that included genetic information to try to improve warfarin dosing. These dosing algorithms hold promise, but have not been fully validated or tested in rigorous clinical trials. Perhaps equally importantly, adherence to warfarin is a major problem that should be addressed with innovative and cost-effective interventions.Conclusion-Additional research is needed to further test whether interventions can be used to improve warfarin dosing and outcomes.

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“…For the major haemorrhage events, pooled results from 7 RCTs (14,15,(23)(24)(25)(26)(27), and 7 cohort studies (11,12,28,(30)(31)(32)34) Figure 4C). Major haemorrhage events was defined as "major bleeding" of the International Society of Thrombosis and Hemostasis (ISTH) which including fatal bleeding in non-surgical patients, symptomatic bleeding, bleeding causing a fall in hemoglobin level of 20g/L, or need for transfusion (36).…”

Section: Haemorrhage Eventsmentioning

confidence: 99%

“…It has been reported that patients managed by AMS or anticoagulation clinic (AC) had better treatment results, especially lower major bleeding rates than personal physician management (6)(7)(8)(9). In addition, several studies reported significant improvements in haemorrhage and thrombosis events with patients in AMS (10)(11)(12). AMS could be managed by pharmacists, physicians, nurses and patient self-management in different models to finish routine work (13).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Pharmacist-led Anticoagulation Management on Clinical Outcomes: A Systematic Review and Meta-Analysis

Hou

Yang

et al. 2017

J Pharm Pharm Sci

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-OBJECTIVES:We performed this systematic review and meta-analysis to confirm whether patients benefit more from pharmacist-led anticoagulation management than other models. METHODS: We searched PubMed, Embase, Cochrane Library and reference lists of yielded results conducted up to April 25, 2017. RCTs and observational cohort studies and case-control studies which compared the percentage of time within the target therapeutic range (TTR), the percentage of time within the expanded therapeutic range (TER), haemorrhage events, thrombosis events, mortality, patient satisfaction and/or medicine cost saving of pharmacist-led anticoagulation management with other models, and species were limited to humans. Two investigators evaluated methodology and extracted data from included studies independently. Data analysis were performed by STATA 12.0 software and quality of evidence assessment was performed by GRADEprofiler software. RESULTS: 8 RCTs and 9 observational cohort studies with 9919 patients were included eventually with high quality and no publication bias. In RCTs pooled results, TTR (p=0.548 moderate-quality), TER (p=0.285, moderate-quality), total haemorrhage events (p=0.140, low-quality), minor haemorrhage events (p=0.162, low-quality), major haemorrhage events (p=0.237, low-quality), thrombosis events (p=0.615, low-quality) and mortality (p=0.876, low-quality) was not significant between two groups.

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Effect of a Centralized Clinical Pharmacy Anticoagulation Service on the Outcomes of Anticoagulation Therapy

Cited by 303 publications

References 13 publications

A Strategy to Develop Advanced Pharmacy Practice Experiences

A Strategy to Develop Advanced Pharmacy Practice Experiences

Warfarin therapy: in need of improvement after all these years

Effectiveness of Pharmacist-led Anticoagulation Management on Clinical Outcomes: A Systematic Review and Meta-Analysis

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