Establishing community pharmacy-based anticoagulation education and monitoring programs.
OBJECTIVE
To determine the process for establishing community pharmacy-based anticoagulation education and monitoring programs using fingerstick capillary whole blood testing.


METHODS
Pilot community-based intervention study using convenience sample of patients.


METHODS
Three community pharmacies with pre-established health education centers and laboratories certified for moderate complexity.


METHODS
26 patients were referred to the clinics by 2 primary care physicians for each pharmacy, most with a diagnosis of atrial fibrillation.


METHODS
Patient assessment, including adherence to prescribed regimens; changes in medication use, including prescription and nonprescription medications, vitamins, health foods, and nutrition supplements; changes in diet and ethanol consumption; assessment of adverse experiences; and needed changes in warfarin dosage.


METHODS
Percentage of international normalized ratio (INR) values within therapeutic range, major bleeding events, and thrombotic events.


RESULTS
A total of 21 patient charts were available for analysis. More than 80% of patients had INR values within their targeted range (+/- 0.2) 60% or more of the time, comparable with values reported for anticoagulation clinics. Of the 235 INR values obtained during the study, 75% were within the individualized targeted therapeutic range (e.g., 2 to 3 +/- 0.2). One patient experienced a major bleeding event related to an underlying cancer. None of the patients experienced a thrombotic event.


CONCLUSIONS
Community pharmacies can effectively implement an anticoagulation education and monitoring program.
Knowlton
C H
CH
Hospice Pharmacia, Philadelphia, PA 19103, USA.
Thomas
O V
OV
Williamson
A
A
Gammaitoni
A R
AR
Kirchain
W R
WR
Buttaro
M L
ML
Zarus
S A
SA
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010353:Patient Education as Topic; D010594:Pharmacies / Q000592:standards*; D010865:Pilot Projects; D011517:Prothrombin Time; D014481:United States
D000925:Anticoagulants