Point‐of‐care monitoring of anticoagulant therapy by rural community pharmacists: Description of successful outcomes

Warfarin is a recognised high‐risk drug for adverse events. Patients from rural and remote regions are at increased risk of these events because of problems of access to health care providers and services, and there is some reluctance to prescribe warfarin to patients in rural areas because of the difficulties in monitoring anticoagulated patients. The availability of portable international normalised ratio (INR) monitors is particularly attractive in rural or remote settings because of the lack of access to pathology services. Pharmacists and other health professionals in rural areas are ideally placed to assist general practitioners in the management of their anticoagulated patients through the use of portable INR monitors. The present article describes three cases of successful outcomes of pharmacist‐assisted anticoagulation monitoring in the rural setting. Innovative service delivery models like these are needed to meet the needs of the increasing number of rural Australians requiring warfarin therapy. What is already known on this subject: There is clear evidence of the under use of warfarin in patients with atrial fibrillation (AF) and under use is greatest in rural areas. One of the barriers to the use of warfarin in these areas is the relative lack of access to pathology services for regular international normalised ratio (INR) testing. What does this study add: Through case studies, the present study demonstrates the practical utility of point‐of‐care INR monitoring in rural and remote communities. Such monitoring has the potential to lead to safer and more effective use of warfarin and therefore to better management of anticoagulated patients in rural and remote areas.