title: Expansion of clinical pharmacy through increased use of outpatient pharmacists for anticoagulation services.
abstract: OBJECTIVE
  The expansion of clinical pharmacy services through increased use of outpatient pharmacists for anticoagulation services is described.
  
  
  CONCLUSIONS
  Due to the high demand for clinical pharmacist services by patients and medical staff at Harris Health System in Houston, Texas, and the strict budgetary restrictions to improve the quality of care through cost-neutral services, a new telephone anticoagulation monitoring service, provided by clinical pharmacists, was established at four of the busiest anticoagulation ambulatory care centers within the system. One clinical staff pharmacist was trained in each of the four clinics by a clinical pharmacy specialist. Each pharmacist received roughly two weeks of training to provide this service. Implementation of the new anticoagulation monitoring service occurred on April 1, 2013. Data collected between October 2011 and April 2014 revealed significantly more visits per month for the clinical pharmacy service after the implementation of the telephone anticoagulation monitoring service (p=0.011). Redistribution of workflow resulted in a 16% increase in clinical pharmacy patient volume at the ambulatory care clinics (p=0.011). The percentage of International Normalized Ratio values in the therapeutic range, the proportion of hospitalizations due to thromboembolic or bleeding events, work hours per prescription volume, project completion rates, and the number of students precepted did not significantly differ between groups.
  
  
  CONCLUSIONS
  The implementation of a clinical pharmacy telephone service for patients receiving anticoagulation at an outpatient center resulted in increased patient clinic visits without adversely affecting patient outcomes or increasing personnel or costs.
authors: Achsah Philip, Pharm.D., M.S., BCPS, is Clinical Informatics Pharmacist, Medication Use Policy and Informatics, Department of Pharmacy Services, Medical University of South Carolina, Charleston; at the time of writing she was Health-System Pharmacy Administration Resident, Harris Health System, Houston, TX. Monica Green, Pharm.D., BCPS, BCACP, is Ambulatory Clinical Manager; and Therese Hoffman, Pharm.D., M.B.A., is Director of Ambulatory Care Service, Harris Health System. Stefani Gautreaux, Pharm.D., M.B.A., is Pharmacy Operations Manager, M. D. Anderson Cancer Center, Houston. David Wallace, Pharm.D., is Clinical Associate Professor, University of Houston College of Pharmacy, Houston. Ryan Roux, Pharm.D., M.S., is Director of Pharmacy Operations, M. D. Anderson Cancer Center. Kevin W. Garey, Pharm.D., M.S., is Professor and Chair, University of Houston College of Pharmacy.
authors: Achsah
authors: A
authors: Philip
authors: Achsah Philip, Pharm.D., M.S., BCPS, is Clinical Informatics Pharmacist, Medication Use Policy and Informatics, Department of Pharmacy Services, Medical University of South Carolina, Charleston; at the time of writing she was Health-System Pharmacy Administration Resident, Harris Health System, Houston, TX. Monica Green, Pharm.D., BCPS, BCACP, is Ambulatory Clinical Manager; and Therese Hoffman, Pharm.D., M.B.A., is Director of Ambulatory Care Service, Harris Health System. Stefani Gautreaux, Pharm.D., M.B.A., is Pharmacy Operations Manager, M. D. Anderson Cancer Center, Houston. David Wallace, Pharm.D., is Clinical Associate Professor, University of Houston College of Pharmacy, Houston. Ryan Roux, Pharm.D., M.S., is Director of Pharmacy Operations, M. D. Anderson Cancer Center. Kevin W. Garey, Pharm.D., M.S., is Professor and Chair, University of Houston College of Pharmacy.
authors: Monica
authors: M
authors: Green
authors: Achsah Philip, Pharm.D., M.S., BCPS, is Clinical Informatics Pharmacist, Medication Use Policy and Informatics, Department of Pharmacy Services, Medical University of South Carolina, Charleston; at the time of writing she was Health-System Pharmacy Administration Resident, Harris Health System, Houston, TX. Monica Green, Pharm.D., BCPS, BCACP, is Ambulatory Clinical Manager; and Therese Hoffman, Pharm.D., M.B.A., is Director of Ambulatory Care Service, Harris Health System. Stefani Gautreaux, Pharm.D., M.B.A., is Pharmacy Operations Manager, M. D. Anderson Cancer Center, Houston. David Wallace, Pharm.D., is Clinical Associate Professor, University of Houston College of Pharmacy, Houston. Ryan Roux, Pharm.D., M.S., is Director of Pharmacy Operations, M. D. Anderson Cancer Center. Kevin W. Garey, Pharm.D., M.S., is Professor and Chair, University of Houston College of Pharmacy.
authors: Therese
authors: T
authors: Hoffman
authors: Achsah Philip, Pharm.D., M.S., BCPS, is Clinical Informatics Pharmacist, Medication Use Policy and Informatics, Department of Pharmacy Services, Medical University of South Carolina, Charleston; at the time of writing she was Health-System Pharmacy Administration Resident, Harris Health System, Houston, TX. Monica Green, Pharm.D., BCPS, BCACP, is Ambulatory Clinical Manager; and Therese Hoffman, Pharm.D., M.B.A., is Director of Ambulatory Care Service, Harris Health System. Stefani Gautreaux, Pharm.D., M.B.A., is Pharmacy Operations Manager, M. D. Anderson Cancer Center, Houston. David Wallace, Pharm.D., is Clinical Associate Professor, University of Houston College of Pharmacy, Houston. Ryan Roux, Pharm.D., M.S., is Director of Pharmacy Operations, M. D. Anderson Cancer Center. Kevin W. Garey, Pharm.D., M.S., is Professor and Chair, University of Houston College of Pharmacy.
authors: Stefani
authors: S
authors: Gautreaux
authors: Achsah Philip, Pharm.D., M.S., BCPS, is Clinical Informatics Pharmacist, Medication Use Policy and Informatics, Department of Pharmacy Services, Medical University of South Carolina, Charleston; at the time of writing she was Health-System Pharmacy Administration Resident, Harris Health System, Houston, TX. Monica Green, Pharm.D., BCPS, BCACP, is Ambulatory Clinical Manager; and Therese Hoffman, Pharm.D., M.B.A., is Director of Ambulatory Care Service, Harris Health System. Stefani Gautreaux, Pharm.D., M.B.A., is Pharmacy Operations Manager, M. D. Anderson Cancer Center, Houston. David Wallace, Pharm.D., is Clinical Associate Professor, University of Houston College of Pharmacy, Houston. Ryan Roux, Pharm.D., M.S., is Director of Pharmacy Operations, M. D. Anderson Cancer Center. Kevin W. Garey, Pharm.D., M.S., is Professor and Chair, University of Houston College of Pharmacy.
authors: David
authors: D
authors: Wallace
authors: Achsah Philip, Pharm.D., M.S., BCPS, is Clinical Informatics Pharmacist, Medication Use Policy and Informatics, Department of Pharmacy Services, Medical University of South Carolina, Charleston; at the time of writing she was Health-System Pharmacy Administration Resident, Harris Health System, Houston, TX. Monica Green, Pharm.D., BCPS, BCACP, is Ambulatory Clinical Manager; and Therese Hoffman, Pharm.D., M.B.A., is Director of Ambulatory Care Service, Harris Health System. Stefani Gautreaux, Pharm.D., M.B.A., is Pharmacy Operations Manager, M. D. Anderson Cancer Center, Houston. David Wallace, Pharm.D., is Clinical Associate Professor, University of Houston College of Pharmacy, Houston. Ryan Roux, Pharm.D., M.S., is Director of Pharmacy Operations, M. D. Anderson Cancer Center. Kevin W. Garey, Pharm.D., M.S., is Professor and Chair, University of Houston College of Pharmacy.
authors: Ryan
authors: R
authors: Roux
authors: Achsah Philip, Pharm.D., M.S., BCPS, is Clinical Informatics Pharmacist, Medication Use Policy and Informatics, Department of Pharmacy Services, Medical University of South Carolina, Charleston; at the time of writing she was Health-System Pharmacy Administration Resident, Harris Health System, Houston, TX. Monica Green, Pharm.D., BCPS, BCACP, is Ambulatory Clinical Manager; and Therese Hoffman, Pharm.D., M.B.A., is Director of Ambulatory Care Service, Harris Health System. Stefani Gautreaux, Pharm.D., M.B.A., is Pharmacy Operations Manager, M. D. Anderson Cancer Center, Houston. David Wallace, Pharm.D., is Clinical Associate Professor, University of Houston College of Pharmacy, Houston. Ryan Roux, Pharm.D., M.S., is Director of Pharmacy Operations, M. D. Anderson Cancer Center. Kevin W. Garey, Pharm.D., M.S., is Professor and Chair, University of Houston College of Pharmacy. kgarey@uh.edu.
authors: Kevin W
authors: KW
authors: Garey
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D000925:Anticoagulants / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010045:Outpatients; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D013339:Students, Pharmacy / Q000706:statistics & numerical data; D013689:Telephone; D013781:Texas; D013923:Thromboembolism / Q000453:epidemiology
chemical_list: D000925:Anticoagulants