title: Implementation of a pharmacist-managed heart failure medication titration clinic.
abstract: OBJECTIVE
  The development, implementation, and initial results of a pharmacist-managed heart failure (HF) medication titration clinic are described.
  
  
  CONCLUSIONS
  In a quality-improvement initiative at a Veterans Affairs health care system, clinical pharmacists were incorporated into the hospital system's interprofessional outpatient HF clinic. In addition, a separate pharmacist-managed HF medication titration clinic was established, in which pharmacists were granted an advanced scope of practice and prescribing privileges, enabling them to initiate and adjust medication dosages under specific protocols jointly established by cardiology and pharmacy staff. Pharmacists involved in the titration clinic tracked patients' daily body weight, vital signs, and volume status using telephone-monitoring technology and via patient interviews. A retrospective chart review comparing achievement of target doses of angiotensin-converting enzyme inhibitor (ACEI), angiotensin-receptor blocker (ARB), and β-blocker therapies in a group of patients (n = 28) whose dosage titrations were carried out by nurses or physicians prior to implementation of the pharmacist-managed HF medication titration clinic and a group of patients (n = 27) enrolled in the medication titration clinic during its first six months of operation indicated that target ACEI and ARB doses were achieved in a significantly higher percentage of pharmacist-managed titration clinic enrollees (52.9% versus 31%, p = 0.007). Patients enrolled in the pharmacist-managed HF medication titration clinic also had a significantly higher rate of attainment of optimal β-blocker doses (49% versus 24.7%, p = 0.012).
  
  
  CONCLUSIONS
  Implementation of a pharmacist-managed HF medication titration clinic increased the percentage of patients achieving optimal ACEI, ARB, and β-blocker dosages.
authors.affiliation: Tampa General Hospital, Tampa, FL 33606, USA. amandamartinez@tgh.org
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Martinez
authors.forename: Jerold
authors.initials: J
authors.lastname: Saef
authors.forename: Anna
authors.initials: A
authors.lastname: Paszczuk
authors.forename: Hetal
authors.initials: H
authors.lastname: Bhatt-Chugani
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D001794:Blood Pressure; D015992:Body Mass Index; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006339:Heart Rate; D006787:Hospitals, Veterans; D006801:Humans; D054539:Medication Therapy Management / Q000458:organization & administration* / Q000592:standards; D008991:Monitoring, Physiologic; D019982:Organizational Case Studies; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration* / Q000592:standards; D010595:Pharmacists / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D012189:Retrospective Studies; D013685:Telecommunications; D016896:Treatment Outcome; D000078329:Workforce
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors