Pharmacists’ confidence when providing pharmaceutical care on anticoagulants, a multinational survey

Abstract

Background Guidelines on the management of orally anticoagulated patients are continuously evolving, leading to an increased need for pharmacists to be fully integrated in care provision. Objective To identify self-reported gaps in confidence among practicing pharmacists in the area of anticoagulation. Setting Pharmacists in different work settings in different countries. Method Cross-sectional international survey from October 2015 till November 2016 among pharmacists working in different settings to assess their level of confidence when delivering anticoagulants as well as to identify possible educational needs regarding this medication class. Validation of the survey was ensured. Results Responses from 4212 pharmacists originating from 18 countries were obtained. Pharmacists’ level of confidence was significantly higher (p < 0.001) when advising patients on vitamin K antagonists (VKAs) versus non-vitamin K antagonists (NOACs). In general, hospital pharmacists displayed higher confidence levels compared to community pharmacists when advising patients on anticoagulation (p < 0.001). Two distinct patterns of confidence levels emerged relating to basic and advanced pharmaceutical care. Confidence levels when providing advanced pharmaceutical care were significantly higher for Oceania and lower for South America (p < 0.005). Conclusions Pharmacists felt more confident in supporting patients receiving VKAs compared to the more recently introduced NOACs. With the increasing use of NOACs and the risks pertaining to anticoagulation therapy, it is essential to invest in education for pharmacists to address their knowledge gaps enabling them to confidently support patients receiving oral anticoagulants.Electronic supplementary materialThe online version of this article (10.1007/s11096-017-0551-2) contains supplementary material, which is available to authorized users.

Assessing Pharmacists Knowledge and Attitude Toward the Direct Oral Anticoagulants in Qatar

“…3 Similarly, Papastergiou and his colleagues reported in an international pharmacist survey in 2017 a significant difference in confidence upon dispensing warfarin versus DOACs. 4 As expected, the study also revealed that pharmacists with clinical experience (carrying a board certification, being involved in more DOACs prescribing or dispensing) had better awareness.…”

“…Pharmacist-led AMS has been shown to improve patient's quality of life, reduce anticoagulation monitoring, and provide a high level of anticoagulation control and patient's satisfaction. [3][4][5] Direct oral anticoagulants (DOACs) were introduced in 2010 and are still considered a relatively new class of non-VKA OACs. Dabigatran, a direct thrombin inhibitor, was the first DOAC to be introduced and was followed by four-factor Xa inhibitors (rivaroxaban, apixaban, edoxaban, and betrixaban).…”

“…Pharmacist-led AMS has been shown to improve patient’s quality of life, reduce anticoagulation monitoring, and provide a high level of anticoagulation control and patient’s satisfaction. 3 – 5 …”

The Quality of Advice Provided by Pharmacists to Patients Taking Direct Oral Anticoagulants: A Mystery Shopper Study

“…Bruising is a side effect of all OACs, whereas the drug interaction and dyspepsia are DOAC-specific complications. Pharmacists have reported being more confident counselling on VKAs [14] and, as bruising is a common side effect of warfarin, pharmacists may be more likely to identify it as a side effect of all OACs. DOACs are also safer medications, potentially leading to fewer investigations into drug interactions.…”

“…Interestingly, pharmacists have been observed to take a different approach when counselling patients on DOACs compared to VKAs [9]. They were less likely to use a checklist to ensure all appropriate points were covered [9], and less confident in their knowledge, skills and access to resources on DOACs [14]. They reported lacking confidence in their ability to manage bleeding and bruising as potential adverse effects, and reported more confidence in general areas of management such as the indication of the medication [14].…”