title: The community pharmacy-based anticoagulation management service achieves a consistently high standard of anticoagulant care.
abstract: OBJECTIVE
  To ensure that the Community Pharmacy-Based Anticoagulation Management Service (CPAMS) in New Zealand has continued to deliver a high standard of anticoagulant care as the service has grown to provide warfarin supervision to over 4,000 patients.
  
  
  METHODS
  A clinical audit of patients managed through CPAMS over two years from 1 January, 2013. Anticoagulant control was assessed by measuring the time in therapeutic range (TTR), proportion of high and low INR results and incidence of reported bleeds. Compliance with the service was evaluated by monitoring the frequency of testing and the interval between tests.
  
  
  RESULTS
  There has been only a modest change in the TTR from 76.4% to 74% during the audit period, despite the growth in patient numbers from 850 to 4,350. There was no change in the proportion of INR results above 4.0. Bleeding was reported in less than 4% of visits and 82% of bleeds were minor. 75% of patients attended for INR testing on the expected date, and only 3.3% were more than 2 weeks overdue. The interval between tests remained constant at approximately 19 days.
  
  
  CONCLUSIONS
  CPAMS provides safe reliable anticoagulant care with a consistently high level of anticoagulant control.
authors.affiliation: Clinical Haematology, Palmerston North Hospital, Palmerston North, New Zealand. paul.harper@midcentraldhb.govt.nz.
authors.forename: Paul
authors.initials: P
authors.lastname: Harper
authors.forename: Ian
authors.initials: I
authors.lastname: McMichael
authors.forename: Dale
authors.initials: D
authors.lastname: Griffiths
authors.forename: Joe
authors.initials: J
authors.lastname: Harper
authors.forename: Claire
authors.initials: C
authors.lastname: Hill
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D054869:Clinical Audit; D003157:Community Pharmacy Services; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010349:Patient Compliance
chemical_list: D000925:Anticoagulants