Is long-term pharmacist-managed anticoagulation service efficient? A pragmatic randomized controlled trial.
BACKGROUND
Some pharmacist-managed anticoagulation services (PMAS) provide initial follow-up to patients on oral anticoagulant, who are transferred to their physician once they are stabilized. This may be as effective as and less expensive than long-term PMAS follow-up.


METHODS
Once PMAS patients were stabilized and ready for discharge, they were randomized to be transferred to their physician or stay with the PMAS. Quality of international normalized ratio (INR) control, incidence of complications, health-related quality of life, use of health care services, and direct incremental cost of PMAS follow-up were evaluated.


RESULTS
One hundred thirty-eight physicians and 250 patients participated. Patients were initially followed at the PMAS for a mean of 11.3 weeks and afterwards were followed by their physician (n = 122) or by the PMAS pharmacists (n = 128) for a mean of 14.9 and 14.5 weeks, respectively. Pharmacist-managed anticoagulation services' and physician's patients were within the exact target range 77.3% and 76.7% of the time (95% CI of the difference -4.9% to 6.0%) and within the extended range 93.0% and 91.6% of the time (95% CI -2.1% to 4.7%), respectively. Pharmacist-managed anticoagulation services patients have seen their family physician less often (95% CI -3.1 to -0.1 visit per year). Number of INR tests, incidence of complications, and health-related quality of life were similar in both groups. The incremental cost of PMAS follow-up was estimated at CAN$123.80 per patient year.


CONCLUSIONS
Once PMAS patients are well stabilized, maintaining a PMAS follow-up or transferring them to their physician is associated with excellent INR control. However, long-term PMAS follow-up may be more expensive.
Lalonde
Lyne
L
Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada. lyne.lalonde@umontreal.ca
Martineau
Josée
J
Blais
Normand
N
Montigny
Martine
M
Ginsberg
Jeffrey
J
Fournier
Martine
M
Berbiche
Djamal
D
Vanier
Marie-Claude
MC
Blais
Lucie
L
Perreault
Sylvie
S
Rodrigues
Isabel
I
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000097:blood; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000191:economics / Q000379:methods; D009864:Ontario; D010593:Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data*; D010595:Pharmacists; D010818:Practice Patterns, Physicians' / Q000191:economics; D024382:Professional Role; D012016:Reference Values; D012680:Sensitivity and Specificity; D013923:Thromboembolism / Q000188:drug therapy* / Q000517:prevention & control; D013997:Time Factors; D017749:Total Quality Management
D000925:Anticoagulants