Pharmacist-managed anticoagulation clinics achieved similar adjusted time in therapeutic range as nurse-managed clinics, but were associated with over seven times lower odds of hospitalizations.
Cohort (n=200)
No
Does a pharmacist-managed anticoagulation clinic improve the proportion of INR in therapeutic range and reduce warfarin-related hospitalizations compared to a nurse-managed clinic in patients treated with warfarin?
Pharmacist-managed anticoagulation clinics may significantly reduce warfarin-related hospitalizations and ED visits compared to nurse-managed clinics, despite achieving similar time in therapeutic range.
Absolute Event Rate: 51.8% vs 56.2%
p-value: p=0.04
Background While systematic anticoagulation management leads to improved outcomes, there is limited data comparing outcomes in anticoagulation clinics managed by pharmacists vs nurses. The objective of this study was to evaluate the effect of pharmacist vs nurse‐managed clinics on the quality of anticoagulation and warfarin‐related hospitalizations and emergency department (ED) admissions. Methods A retrospective observational cohort study of patients treated with warfarin and referred to a pharmacist‐managed anticoagulation clinic (PMAC) or a nurse‐managed anticoagulation clinic (NMAC) was conducted at the University of Illinois Hospital and Health Sciences System. The primary outcome was the proportion of international normalized ratio levels in therapeutic range (PIR). The secondary outcome was warfarin‐related hospitalizations and ED visits. Multivariate regression models were used to evaluate the effect of the model of care (PMAC vs NMAC) on PIR and hospitalization/ED visits, respectively. An economic evaluation of adverse events was also undertaken. Results A total of 200 consecutive patients (100 patients in the PMAC group and 100 patients in the NMAC group) were included. The majority of patients were females (58. 5%) and average age was 61. 4 ± 14. 6 years. Patients in the PMAC group were more nonadherent to warfarin therapy and had more than three missed clinic appointments compared with the NMAC group (19. 1% ± 10. 1% vs 4. 1% ± 4. 1%, P < 0. 05; and 78% vs 33%, P < 0. 05) respectively. The average PIR was 51. 8% ± 15. 9% and 56. 2% ± 13. 9% (P = 0. 04) in the PMAC and NMAC groups, respectively. After controlling for confounders, the adjusted PIR was not different between the two groups. The NMAC group, however, had over seven times greater odds of hospitalization/ED visits compared to the PMAC group. The PMAC saved 505 349 over a 1. 25 year period. Conclusion The quality of warfarin anticoagulation did not differ between pharmacist and nurse‐managed models of anticoagulation care, however, PMACs decreased the odds of warfarin‐related hospitalizations/ED visits and their associated costs.
Manzoor et al. (2018) conducted a cohort in Warfarin anticoagulation (n=200). Pharmacist-managed anticoagulation clinic vs. Nurse-managed anticoagulation clinic was evaluated on Proportion of international normalized ratio levels in therapeutic range (PIR) (p=0.04). Pharmacist-managed anticoagulation clinics achieved similar adjusted time in therapeutic range as nurse-managed clinics, but were associated with over seven times lower odds of hospitalizations.