December 14, 2023BJGP OpenOpen Access

Pharmacist-led interventions in optimising the use of oral anticoagulants in patients with atrial fibrillation in general practice in England: a retrospective observational study

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Why the study?

Prescribing DOACs for patients with established AF poses challenges, and general practice pharmacists may help optimise OAC therapies.

Does a pharmacist-led intervention improve oral anticoagulant prescribing and reduce inappropriate dosing in patients with atrial fibrillation?

Population

Patients with AF in general practices in Bradford

Comparison

Pre- vs post-pharmacist-led interventions

Design

Retrospective observational study

Authors

RSRaman SharmaNational Institute of Technology Hamirpur SHSyed Shahzad HasanUniversity of Huddersfield IGIshtiaq A GilkarHorton General Hospital

Discussion

Member takes

Implication

May support pharmacist-led DOAC optimization in primary care AF; hypothesis-generating and requires RCTs before practice change.

Structured PICO

Does a pharmacist-led intervention improve oral anticoagulant prescribing and reduce inappropriate dosing in patients with atrial fibrillation?

Population

616 adults (aged ≥18 years) with a confirmed non-valvular atrial fibrillation diagnosis on the Quality and Outcomes Framework (QOF) AF register across 21 general practices in Bradford, UK.

Intervention

Pharmacist-led medicines optimisation interventions, including medication reviews, DOAC dose adjustments, bleeding risk management, and transition from VKA to DOAC therapy.

Comparator

Pre-intervention prescribing practices for oral anticoagulant (OAC) treatment (retrospective pre-post comparison).

Outcome

OAC prescribing rates pre- and post-intervention by pharmacists.

Pharmacist-led interventions in general practice significantly improved appropriate DOAC prescribing, corrected dosing errors, and reduced bleeding risk scores in patients with atrial fibrillation.

Limitations

Conducted across 21 general practices with varying processes
Differences in patient demographics, ethnicity, and deprivation were not considered
No economic analysis or evaluation was included
Patient follow-up was limited to the study period

Cite This Study

Sharma et al. (2023) studied this question.

synapsesocial.com/papers/6a7f71b0221f4e86c3a6f3f1 https://doi.org/10.3399/bjgpo.2023.0113

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