title: Evaluation of pharmacist-based compared to doctor-based anticoagulation management in Qatar.
abstract: OBJECTIVE
  For over 60 years, warfarin has been the mainstay anticoagulant used in the outpatient setting for the prevention and treatment of a wide variety of thromboembolic clinical conditions. Guidelines recommend that health care providers managing oral anticoagulation therapy should do so in a systematic and coordinated fashion. Studies have shown that, when compared to traditional doctor-based anticoagulation management, pharmacist-managed anticoagulation services can improve patient outcomes. The first pharmacist-based anticoagulation clinic in Qatar was launched in 2013 at Alwakra Hospital. The primary objective of this research was to evaluate the impact of pharmacist versus doctor-based anticoagulation management on the percentage time under therapeutic INR (International Normalized Ratio; TTR), INR within therapeutic range and the extreme out of range INRs.
  
  
  METHODS
  A retrospective cohort study was designed to compare the anticoagulation control of pharmacist-based warfarin clinic to the usual doctor-care.
  
  
  RESULTS
  Data from 278 patients taking warfarin (78 managed at pharmacist and 200 at doctor-based clinic) were evaluated. Subjects followed at the pharmacist-based clinic had a superior TTR compared to those managed at the doctor-based clinic (81.8% vs. 69.8%, P < 0.001). Additionally, the percentage of visits within therapeutic range were significantly higher in the pharmacist's group compared to doctor's group (76.5% vs. 71.2%, P = 0.011). At the same time, percentage of visits with extreme subtherapeutic INR was reduced in the pharmacist-managed clinic (5.17% vs. 7.05%, P = 0.007) CONCLUSIONS: Our study indicates that pharmacist-based anticoagulation has better INR control when compared to the traditional anticoagulation management. Pharmacist-managed anticoagulation clinics should be considered and supported for warfarin management.
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: Hazem
authors.initials: H
authors.lastname: Elewa
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Jalali
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: Nada
authors.initials: N
authors.lastname: Khudair
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: Noha
authors.initials: N
authors.lastname: Hassaballah
authors.affiliation: Pharmacy Department, Alwakra Hospital, Doha, Qatar.
authors.forename: Osama
authors.initials: O
authors.lastname: Abdelsamad
authors.affiliation: Pharmacy Department, Heart Hospital, Doha, Qatar.
authors.forename: Shaban
authors.initials: S
authors.lastname: Mohammed
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D000925:Anticoagulants / Q000008:administration & dosage*; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010595:Pharmacists; D010819:Physician's Role; D011780:Qatar; D012189:Retrospective Studies; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: TTR; anticoagulation; anticoagulation clinic; doctor; doctor-managed; pharmacist; pharmacist-managed; warfarin