title: Effect of access to anticoagulation management services on warfarin use in patients with atrial fibrillation.
abstract: OBJECTIVE
  To determine the effect of access to ambulatory anticoagulation management services (AMS) on the rate of warfarin use in patients with atrial fibrillation.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Two ambulatory care clinics in the same managed care system: one with and one without access to pharmacist-managed AMS.
  
  
  METHODS
  One hundred seventy-eight patients with atrial fibrillation diagnosed between June 2000 and June 2001.
  
  
  RESULTS
  Warfarin use was assessed overall and by contraindications and risk factors for stroke. Independent predictors of therapy were identified. The overall rate of warfarin use in atrial fibrillation was higher in the clinic with access to AMS than in the clinic without access (77.9% vs 61.7%, p=0.03). In patients with no known contraindications, warfarin use increased by 20.2% with access to AMS versus no access (80.2% vs 60.0%, p=0.023). Patients aged 65 years or older with one or more risk factors for stroke and no contraindications were more likely to receive warfarin in the clinic with access to AMS than in the clinic without access (85.1% vs 53.8%, p=0.001). Access to AMS was an independent predictor of warfarin use (odds ratio 2.19, 95% confidence interval [CI] 1.05-4.56). Female sex was an independent negative predictor of warfarin use (odds ratio 0.48, 95% CI 0.24-0.96).
  
  
  CONCLUSIONS
  In the managed care setting, use of warfarin for stroke prophylaxis in patients with atrial fibrillation was higher in the ambulatory care clinic with access to pharmacist-managed AMS than in the clinic without access.
authors.affiliation: Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois 60515, USA. jburki@midwestern.edu
authors.forename: Jill S
authors.initials: JS
authors.lastname: Burkiewicz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors; D012737:Sex Factors; D013038:Specialization; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin