title: Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic.
abstract: BACKGROUND
  The beneficial outcomes of oral anticoagulation therapy are dependent upon achieving and maintaining an optimal INR therapeutic range. There is growing evidence that better outcomes are achieved when anticoagulation is managed by a pharmacist with expertise in anticoagulation management rather than usual care by family physicians. This study compared a pharmacist managed anticoagulation program (PC) to usual physician care (UC) in a family medicine clinic.
  
  
  METHODS
  A retrospective cohort study was carried out in a family medicine clinic which included a clinical pharmacist. In 2006, the pharmacist assumed anticoagulation management. For a 17-month period, the PC group (n = 112) of patients on warfarin were compared to the UC patients (n = 81) for a similar period prior to 2006. The primary outcome was the percentage of time patients' INR was in the therapeutic range (TTR). Secondary outcomes were the percentage of time in therapeutic range within ± 0.3 units of the recommended range (expanded TTR) and percentage of time the INR was >5.0 or <1.5.
  
  
  RESULTS
  The baseline characteristics were similar between the groups. Fifty-five percent of the PC group was male with a mean age of 67 years; 51% of the UC group was male with a mean age of 71 years. The most common indications for warfarin in both groups were atrial fibrillation, mechanical heart valves and deep vein thrombosis. The TTR was 73% for PC and 65% for UC (p < 0.0001). The expanded TTR for PC was 91% and 85% for UC (p < 0.0001). The percentage of time INR values were <1.5 was 0.7% for PC patients and 1.9% for UC patients (p < 0.0001), and >5 were 0.3% for PC patients and 0.1% for UC (p < 0.0001).
  
  
  CONCLUSIONS
  The pharmacist-managed anticoagulation program within a family practice clinic compared to usual care by the physicians achieved significantly better INR control as measured by the percentage of time patients' INR values were kept in both the therapeutic and expanded range. Based on the results of this study, a collaborative family practice clinic using pharmacists and physicians may be an effective model for anticoagulation management with these results verified in future prospective randomized studies.
authors.affiliation: School of Pharmacy, Memorial University, St. John's, Canada. swyoung@mun.ca
authors.forename: Stephanie
authors.initials: S
authors.lastname: Young
authors.forename: Lisa
authors.initials: L
authors.lastname: Bishop
authors.forename: Laurie
authors.initials: L
authors.lastname: Twells
authors.forename: Carla
authors.initials: C
authors.lastname: Dillon
authors.forename: John
authors.initials: J
authors.lastname: Hawboldt
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Shea
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D000925:Anticoagulants / Q000627:therapeutic use*; D015331:Cohort Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants