Authors (including presenting author) :
Wong YY(1), YOUNG WM(1), CHU LM(1), YAM PW(2),KWAN YK(2), HO YY(2), HA CY(2), KWOK KC(3)
Affiliation :
(1)Pharmacy Department, Tuen Mun Hospital (2)Department of Medicine and Geriatrics, Tuen Mun Hospital (3)Specialist Out-Patient Department, Tuen Mun Hospital
Introduction :
Tuen Mun Hospital (TMH) has implemented a Pharmacist Anticoagulation Clinic (PAC) in September 2019. The clinic aims to improve care of patients on anticoagulant therapy, to optimize healthcare resources in Medicines and Geriatrics (M&G) specialist outpatient clinic and to empower patients on drug management via pharmacist provided education and counseling.
Objectives :
This review evaluated the extent of improvement of anticoagulation management and optimization of healthcare resources in TMH. The primary outcome is the time in therapeutic range (TTR) and expanded TTR before and after PAC implementation. The secondary outcome is the optimization of healthcare resource in M&G by sparing doctor’s clinic sessions.
Methodology :
The PAC service review started from Sept 2019, patients recruited from Sept 2019 to Jun 2020 are included. The TTRs were retrospectively drawn from laboratory data and calculated by Rosendaal method. Appointment dates were collected from electronic patient record for determination of follow-up interval by M&G Doctor before and after PAC referral. The average of three M&G Doctor’s follow-up intervals before PAC referral and the interval of PAC referral till first M&G clinic follow-up were used in the study.
Result & Outcome :
A total of 392 patients were included in TTR calculation. The TTR before and after PAC implementation was 57.3% and 65.9% respectively with mean difference 8.66% (95%CI 4.97%-12.35%, p< 0.0001). The expanded TTR before and after PAC implementation was 73.2% and 82.8% respectively with mean difference 9.59% (95%CI 6.36%-12.82%, p< 0.0001). The average of M&G follow-up interval before and after was found to be 9.81±4.98 weeks and 20.15±7.81 weeks respectively. Hence the extension of M&G Doctor follow-up interval is 10.34 weeks (95%CI 9.76-10.93, p< 0.0001). After PAC introduction, doctor warfarin clinics were decreased from 8 sessions to 2 sessions weekly, i.e. saving of 312 doctor sessions annually in caring for warfarin patients. This review showed that pharmacist clinic can provide good patient care and alleviate doctor workload by extending doctors’ follow-up interval. To conclude, the care model of PAC is safe and cost-effective. The collaboration of pharmacist and doctor in PAC demonstrated that pharmacists have potential to optimize patient health care in ambulatory care settings.
