Authors (including presenting author) :
Cheung MH(1), Chung HMM(1), Fong WC(2), Lee KYM(2), You HSJ(3), Leung WYS(1), Lau LF(1), Lam MWS(1), Cheung MY(1)
Affiliation :
(1)Department of Pharmacy, Queen Elizabeth Hospital, (2)Department of Medicine, Queen Elizabeth Hospital, (3)School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong
Introduction :
Drug-related problems are not uncommon in the use of direct oral anticoagulants (DOACs). A pharmacist-managed outpatient service has been implemented in a Hong Kong major public hospital to improve the utilisation of DOACs.
Objectives :
The main objectives of the study are to assess the impact of the service on the appropriateness of newly initiated DOAC prescriptions, to measure patients’ adherence to DOAC therapy under the service, and to evaluate physicians’ acceptance of recommendations made by pharmacists providing the service.
Methodology :
All patients who participated in the DOAC service, which included all medical outpatients newly prescribed a DOAC agent that was dispensed at the institution’s pharmacy, between November 2019 and April 2020 were included in this retrospective analysis. The primary outcome was the proportion of patients given DOAC therapy in accordance with the recommendations from international clinical practice guidelines before and after pharmacist intervention. Secondary outcomes included patients’ adherence to DOAC therapy at week 4 after drug initiation, rate of physicians’ acceptance of pharmacist recommendations, and patient satisfaction with the service. The DOAC therapy evaluation forms, follow-up assessment forms, and patient satisfaction surveys completed during the study period were collected for data analysis. The therapy evaluation forms were reviewed and the assessments of the therapy appropriateness before and after pharmacist intervention were verified by a second pharmacist.
Result & Outcome :
A total of 115 patients were evaluated. The number (percentage) of patients given recommended DOAC therapy increased from 87 (75.7%) to 101 (87.8%) after pharmacist intervention (p< 0.001). A total of 32 drug-related problems were identified, with dose-related problems being the most common type (43.8%), followed by problems with washout period for anticoagulant switching (31.3%) and concurrent antiplatelet therapy (18.8%). The median adherence rate to DOAC therapy at week 4 was 98.0% by pill count. A total of 36 recommendations were made to prescribers by pharmacists and 23 (63.9%) of them were accepted. The majority of the patients were satisfied with the service, with the overall mean satisfaction score being 9.0 out of 10.
