Authors (including presenting author) :
Mak WC (1), Ng KY(1), Wong OW(1), Lam PY(2), Wong B(1), Chan YS(1), Lee KF(3)
Affiliation :
(1) Pharmacy, Kwong Wah Hospital; (2) Pharmacy, Wong Tai Sin Hospital; (3) Department of Medicine and Geriatrics, Kwong Wah Hospital
Introduction :
Oral anticoagulants (OACs) are globally recognized high alert medications that require timely and multidisciplinary therapeutic monitoring according to international guidelines. However, due to heavy patient load in our Medical Outpatient Clinic (MOPC), not all patients receiving OACs could be reviewed by physicians within the recommended follow-up intervals.
Objectives :
1. To provide timelier and multidisciplinary OAC therapeutic monitoring to patients
2. To relieve physicians’ workload on OAC therapeutic monitoring
3. To improve patient safety by early identification and intervention on drug-related problems (DRPs)
Methodology :
A full-time pharmacist-managed anticoagulant clinic (PAC) was established. Experienced clinical pharmacists specialized in pharmacotherapy and anticoagulant management were the service providers. PAC pharmacists were authorized to prescribe OACs and order blood tests according to service protocol. After attending MOPC consultations, stable patients with Warfarin prescription duration ≥ 12 weeks or direct-acting oral anticoagulants (DOACs) prescription duration ≥ 24 weeks were automatically referred to attend PAC upon drug collection at Pharmacy. Clinical pharmacists would arrange PAC appointments and order appropriate laboratory tests in between 2 consecutive MOPC bookings so as to achieve an INR monitoring for Warfarin < every 12 weeks or a review for DOACs < every 24 weeks. Moreover, physician referrals for MOPC patients requiring special attentions, or post-discharge drug titration/education would also be entertained.
Result & Outcome :
From 1/9/2019 to 31/10/2020, 3352 PAC attendances were recorded, including 2721 scheduled consultations, 152 ad-hoc consultations, and 479 phone follow-ups. The mean duration of Warfarin prescriptions increased from 65.24 days (1/9/2018 to 31/3/2019, before establishing PAC) to 74.69 days (1/9/2019 to 31/3/2020, after establishing PAC), and further increased to 83.51 days (1/4/2020 to 31/10/2020). Similar trends were also observed in all DOACs. Hence, theoretically physicians could spend less time on stable patients and more time on new/difficult cases. Pharmacists routinely manage all DRPs caused by OACs during PAC consultations. In addition, 358 DRPs not caused by OACs were also intervened to physicians/patients (1/4/2020 to 31/12/2020). The acceptance rate of these pharmacist interventions was 89.7%. Moreover, a phone patient satisfaction survey was conducted by random sampling on 61 patients, the overall satisfaction on PAC service was 4.2±0.45 out of 5.
