Evaluation of Anticoagulation Management and Chronic Disease State Control in a Pharmacist-Run Pharmacotherapy/Anticoagulation Clinic

Background: The benefit of pharmacist-run clinics for anticoagulation, dyslipidemia, diabetes, and hypertension has been described in the literature as individual services. We describe a clinic model in which anticoagulation and other chronic disease states are managed concomitantly. Objective: To evaluate the control of anticoagulation, hypertension, dyslipidemia, and diabetes in anticoagulation patients enrolled in a pharmacotherapy/anticoagulation clinic. Methods: Patients seen in the pharmacotherapy/anticoagulation clinic for management of anticoagulation were included in a retrospective review. Demographic information, blood pressure measurements, and laboratory values were recorded. Initial and final results were compared and statistically analyzed. Benchmark goals were set for each parameter analyzed. Results: Between August 2007 and July 2008, 282 patients were enrolled in the clinic. While slightly increasing the average time in therapeutic range from 69.9% to 70.7%, the clinical pharmacists also managed hypertension, dyslipidemia, and diabetes, if present. Systolic (p = 0.0075; 95% CI 0.98 to 6.31) and diastolic (p = 0.004; 95% CI 1.26 to 4.33) blood pressures decreased during the study period such that the number of patients with controlled blood pressure increased to 81%. Low-density lipoprotein cholesterol measurements decreased by an average of 5.9 mg/dL (p < 0.0001; 95% CI 3.121 to 8.789), with an increase in number of patients at goal to 86%. Although not significant, mean hemoglobin A 1c (A1C) values decreased an average of 0.12% (p = 0.1138; 95% CI 0.029 to 0.271), with an increase to 59% of those achieving a goal A1C. Conclusions: A pharmacotherapy/anticoagulation clinic can be considered a practice model for effective management of anticoagulation patients who require management of other chronic disease states.