title: Stepwise approach to implementing ambulatory clinical pharmacy services.
abstract: OBJECTIVE
  A methodological approach was developed to facilitate expansion of clinical pharmacist-managed anticoagulation services across an integrated health care delivery network.
  
  
  METHODS
  A stepwise approach to the development and implementation of ambulatory care clinical pharmacy services was used to facilitate expansion of pharmacist-managed anticoagulation clinics in a university hospital setting and a community hospital within the same health network.
  
  
  RESULTS
  The Health Alliance of Greater Cincinnati successfully created a care delivery model using clinical pharmacists to provide comprehensive anticoagulation management services at a university hospital and a community hospital. The incidence of thromboembolic events was significantly lower in the pharmacy anticoagulation service patients versus the patients in the usual care setting (p=0.005). A statistically significant decrease in minor bleeding events was observed in the pharmacist-managed group (p=0.038). Although a decrease in major bleeding events was observed, it was not statistically significant (p=0.075). International Normalized Ratio values of the patients managed by the pharmacy anticoagulation clinics were within the therapeutic range approximately 75% of the time.
  
  
  CONCLUSIONS
  A stepwise approach to the development and implementation of ambulatory care clinical pharmacy services has facilitated the expansion of pharmacist-managed anticoagulation clinics across an integrated health system. This may serve as a valuable template for other systems as they strive to develop medication therapy management services.
authors.affiliation: Ambulatory Care Pharmacy Services, Health Alliance, Florence, KY 41042, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Epplen
authors.forename: Michelle
authors.initials: M
authors.lastname: Dusing-Wiest
authors.forename: Joanna
authors.initials: J
authors.lastname: Freedlund
authors.forename: Nicole
authors.initials: N
authors.lastname: Harger
authors.forename: Susan
authors.initials: S
authors.lastname: Kathman
authors.forename: Marianne F
authors.initials: MF
authors.lastname: Ivey
mesh_terms: D000553:Ambulatory Care; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D019033:Delivery of Health Care, Integrated; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010044:Outpatient Clinics, Hospital; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D024382:Professional Role; D013923:Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants