title: Impact of Point-of-Care Implementation in Pharmacist-Run Anticoagulation Clinics Within a Community-Owned Health System: A Two-Year Retrospective Analysis.
abstract: BACKGROUND
  Point-of-care (POC) testing devices allow laboratory monitoring to be performed in various settings and accessed immediately.
  
  
  OBJECTIVE
  To evaluate the outcomes of monitoring anticoagulation patients in pharmacistmanaged, multicenter clinics utilizing i-STAT POC machines.
  
  
  METHODS
  This study was a retrospective, multicenter chart review of 150 patients before and after implementation of the POC intervention for anticoagulation monitoring. Data collected included international normalized ratio (INR) results, indication for warfarin, minor and major bleeds, thromboembolic events, emergency room (ER) visits, and hospitalizations before and after i-STAT POC implementation.
  
  
  RESULTS
  The time in therapeutic INR range (TTR) was significantly higher after i-STAT POC implementation than before implementation (60.4% ± 21.2% and 52.5% ± 21.5%, respectively; P = .0001). There were no reports of major bleeding during the study period. Twenty-three minor bleeds were reported after i-STAT POC implementation compared to 19 events before implementation (P < .0001). One thromboembolic event was reported after i-STAT POC implementation. There was a significant difference in the number of hospitalizations before i-STAT POC implementation as opposed to after implementation (2 and 0, respectively; P < .0001). There was also a significant increase in ER visits after i-STAT POC implementation (P < .0001).
  
  
  CONCLUSIONS
  The results of the study indicate improvement in TTR in pharmacist-managed anticoagulation clinics by 7.8%. Although the use of the i-STAT POC machine detected an increase in minor bleeds, thromboembolic events, and ER visits, there was a decrease in hospitalization. The outcomes of this multicenter study indicate that implementation on this scale provides improvement in regard to safety and cost.
authors.affiliation: Assistant Professor of Pharmacy Practice, St. Louis College of Pharmacy , St. Louis, Missouri.
authors.forename: Laura
authors.initials: L
authors.lastname: Challen
authors.affiliation: Clinical Pharmacist II, Settegast Health Center , Houston, Texas.
authors.forename: Sylvester
authors.initials: S
authors.lastname: Agbahiwe
authors.affiliation: Clinical Pharmacist II, Strawberry Health Center , Pasadena, Texas.
authors.forename: Tara
authors.initials: T
authors.lastname: Cantieri
authors.affiliation: Clinical Pharmacist II, Aldine Health Center , Houston, Texas.
authors.forename: Jessica Garcia
authors.initials: JG
authors.lastname: Olivetti
authors.affiliation: Clinical Pharmacist II, Martin Luther King Jr. Health Center , Houston, Texas.
authors.forename: Theophilus
authors.initials: T
authors.lastname: Mbah
authors.affiliation: Clinical Pharmacist II, Vallbona Health Center , Houston, Texas.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Mendoza-Becerra
authors.affiliation: Clinical Pharmacist II, E.A. "Squatty" Lyons Health Center , Humble, Texas.
authors.forename: Cesar
authors.initials: C
authors.lastname: Munoz
authors.affiliation: Clinical Pharmacist, CommUnityCare , Austin, Texas.
authors.forename: Michelle
authors.initials: M
authors.lastname: Nguyen
authors.affiliation: Clinical Pharmacist II, El Franco Lee Health Center , Houston, Texas.
authors.forename: Katashia
authors.initials: K
authors.lastname: Partee
authors.affiliation: Clinical Program Manager, Cigna , Missouri City, Texas.
authors.forename: Lincy
authors.initials: L
authors.lastname: Lal
authors.affiliation: Clinical Pharmacist II, Gulfgate Health Center , Houston, Texas.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Clinical Pharmacy Manager, Ambulatory Services, Harris Health System, Kirby Administrative Office , Houston, Texas .
authors.forename: Monica
authors.initials: M
authors.lastname: Green
keywords: pharmacist anticoagulation clinic; point of care; warfarin