Impact of a Direct Oral Anticoagulation Population Management Tool in a Pharmacist-Led Outpatient Anticoagulation Service
by Jessica A. Wedel, PharmD, Carla E. Staresinic, PharmD, BCACP, Jillian Kolasinski, 2022 PharmD Candidate, Amanda Margolis, PharmD, MS, BCACP, Andrea L. Porter, PharmD
"Background: Clinical guidelines indicate that direct oral anticoagulants (DOACs) require periodic monitoring but do not define the optimal workflow for this required monitoring. Objectives: To evaluate the impact of a population management tool (PMT) on pharmacist interventions compared to traditional management of DOACs in an outpatient pharmacist-led anticoagulation (AC) service. Pharmacist time spent and occurrence of bleeding and thromboembolism were reviewed as secondary objectives.
Methods: A retrospective analysis was conducted of patients on DOAC therapy managed by a pharmacist-led AC clinic. A query of the healthsystem pharmacy database was performed to identify all patients initially prescribed a DOAC from April 2016 to April 2017, to represent pharmacist monitoring using a traditional model, and from April 2018 to April 2019, to represent monitoring with a PMT. Patients were randomly selected from each respective monitoring model for chart review. Pharmacist interventions, including lab ordering, were tracked as the primary outcome. Pharmacist time invested per patient encounter and safety outcomes were assessed as a secondary outcomes.
Results: A total of 150 patient charts (n=75 for each model) were reviewed. The traditional model yielded more overall interventions than the PMT model (249 vs. 127, respectively). However, if routine lab ordering was excluded, the PMT model yielded a higher number of clinical interventions (66 vs. 82, respectively). Besides lab monitoring, there were statistically significant differences in DOAC discontinuation, DOAC dose change, and changes to GI prophylaxis captured between models.
Conclusions: DOAC monitoring using the PMT approach may offer an effective alternative to traditional monitoring to reduce the need for unnecessary lab ordering while still capturing necessary clinical interventions."
Keywords: Pharmacists, Retrospective Studies, Workflow, Outpatients, Thromboembolism, Anticoagulants, Hemorrhage, Blood Coagulation, Pharmacy
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2021 November/December Table of Contents
"Background: Clinical guidelines indicate that direct oral anticoagulants (DOACs) require periodic monitoring but do not define the optimal workflow for this required monitoring. Objectives: To evaluate the impact of a population management tool (PMT) on pharmacist interventions compared to traditional management of DOACs in an outpatient pharmacist-led anticoagulation (AC) service. Pharmacist time spent and occurrence of bleeding and thromboembolism were reviewed as secondary objectives.
Methods: A retrospective analysis was conducted of patients on DOAC therapy managed by a pharmacist-led AC clinic. A query of the healthsystem pharmacy database was performed to identify all patients initially prescribed a DOAC from April 2016 to April 2017, to represent pharmacist monitoring using a traditional model, and from April 2018 to April 2019, to represent monitoring with a PMT. Patients were randomly selected from each respective monitoring model for chart review. Pharmacist interventions, including lab ordering, were tracked as the primary outcome. Pharmacist time invested per patient encounter and safety outcomes were assessed as a secondary outcomes.
Results: A total of 150 patient charts (n=75 for each model) were reviewed. The traditional model yielded more overall interventions than the PMT model (249 vs. 127, respectively). However, if routine lab ordering was excluded, the PMT model yielded a higher number of clinical interventions (66 vs. 82, respectively). Besides lab monitoring, there were statistically significant differences in DOAC discontinuation, DOAC dose change, and changes to GI prophylaxis captured between models.
Conclusions: DOAC monitoring using the PMT approach may offer an effective alternative to traditional monitoring to reduce the need for unnecessary lab ordering while still capturing necessary clinical interventions."
Keywords: Pharmacists, Retrospective Studies, Workflow, Outpatients, Thromboembolism, Anticoagulants, Hemorrhage, Blood Coagulation, Pharmacy
Download PDF
2021 November/December Table of Contents