Health Care Expenditures and Therapeutic Outcomes of a Pharmacist‐Managed Anticoagulation Service versus Usual Medical Care

Hall, Deanne L.; Buchanan, Julianne; Helms, Bethany; Eberts, Matthew W.; Mark, Scott M.; Manolis, Chronis; Peele, Pamela B.; Docimo, Anne

doi:10.1592/phco.31.7.686

Cited by 48 publications

(79 citation statements)

References 19 publications

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“…The current finding is supported by several previous investigations [22][23][24][25] 25 respectively clearly support the results of the present study. All evidences necessitate the collaborative role of clinical pharmacist intervention in order to achieve optimal INR levels in the patients with warfarin therapy.…”

Section: Fig 1: the Percentage Of Patients With Inr Within The Targesupporting

confidence: 93%

Untitled

2017

IJPSR

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Introduction:The warfarin management programs include mainly routine INR measurement, dosing protocols, clinical management protocols for excessive anticoagulation, and patient education. There have been numerous investigations to explore the most appropriate model for outpatients, accordingly different Anticoagulation Management Programs have been emerged in practice. Aims and objectives: This study is an attempt to develop concise warfarin protocol that expands role for the community pharmacist in Iraq. Patients and methods: A prospective case-controlled carried out on patients discharged from the hospital on warfarin therapy in combination to their prescribed medications. The follow up was achieved by four visits starting from 8-10 days after hospital discharge until 90 days. patients who were allocated into Intervention group received designed warfarin management program , and control group on 'usual care' monitoring. Results: The percentage of patients with international normalized ratio (INR) levels is within therapeutic/target range in the intervention group was significantly higher than that in the control group (66.67% vs. 34.78%) after 90 days of monitoring program (p˂0.05). During 90 days of follow up, the total percentage of time therapeutic range (TTR) for the intervention group was (57.68%), and (44.92%) for the control group. Patient adherence to warfarin was (100%) in intervention group compared to control group (p˂0.05). Conclusions: The intervention group demonstrated higher percentage of patients with INR levels within therapeutic/target range, following the management program, and significant improvement in time therapeutic range (TTR) from admission to 90 days post discharge. Accordingly, many promising strategies emerged from pharmacist warfarin-management program.

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Section: Fig 1: the Percentage Of Patients With Inr Within The Targesupporting

confidence: 93%

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2017

IJPSR

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“…There were 17 studies (11,12,14,15,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), including 8 RCTs (14,15,(22)(23)(24)(25)(26)(27), and 9cohort studies (11,12,(28)(29)(30)(31)(32)(33)(34), and 9919 patients involved in total. Our research showed that lower risk of total haemorrhage events, minor haemorrhage events and thrombosis events in pharmacist-led management group, but the percentage of time within target therapeutic range and the percentage of time within the expanded therapeutic range, major haemorrhage events and mortality were not significantly different between pharmacist-led management model and other management models.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with former reviews, we searched relevant articles more comprehensively and updated some new and high quality studies (29)(30)(31)(32)(33)(34) into the review. We reviewed outcomes TTR, TER, haemorrhage events (total, minor, major), thrombosis events, mortality, patient satisfaction and cost saving, which were more considerately and precisely than former reviews.…”

Section: Discussionmentioning

confidence: 99%

“…One RCT (24), and 2 observational cohort study (11,33), reported cost of anticoagulation management in different currency units and time units. Chan et al indicated a significant reduction of the cost per patient per month in pharmacist management group ($76±95 vs $98±158, p<0.01, 2006) (24).…”

Section: Medicine Cost Savingmentioning

confidence: 99%

“…Chan et al indicated a significant reduction of the cost per patient per month in pharmacist management group ($76±95 vs $98±158, p<0.01, 2006) (24). Hall et al reported that the overall net medical care costs savings that accounting for anticoagulation service operational costs and available pharmacy expenditures was $3697 per patient in the pharmacist-managed anticoagulation service group (33). The total cost contained anticoagulation therapy follow-up, hospitalizations and emergency room visits that related to warfarin use were lower in pharmacist management group ($35326/100 patientyears vs $167412/100 patient-years, 1998) from Chiquette et al study (11).…”

Section: Medicine Cost Savingmentioning

confidence: 99%

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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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Outcomes of systematic anticoagulation management in pharmacist and nurse specialized clinics

Manzoor

Bauman

Shapiro

et al. 2018

J Am Coll Clin Pharm

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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.

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Health Care Expenditures and Therapeutic Outcomes of a Pharmacist‐Managed Anticoagulation Service versus Usual Medical Care

Abstract: After accounting for operational costs, pharmacist-managed anticoagulation leads to reduced health care expenditure while improving therapeutic outcomes compared with usual medical care.

Cited by 48 publications

References 19 publications

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

Outcomes of systematic anticoagulation management in pharmacist and nurse specialized clinics

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