title: The first pharmacist-managed anticoagulation clinic under a collaborative practice agreement in Qatar: clinical and patient-oriented outcomes.
abstract: OBJECTIVE
  Optimal outpatient anticoagulation management requires a systematic and coordinated approach. Extensive evidence regarding the benefits of pharmacist-managed anticoagulation services has been reported in the literature. The quality and outcomes associated with pharmacist-managed anticoagulation clinics under collaborative practice agreements in the Middle East have rarely been reported. The first pharmacist-managed ambulatory anticoagulation clinic in Qatar was launched at Al-Wakrah Hospital in March 2013. The objectives of this study were to: (i) describe the practice model of the clinic, (ii) evaluate the quality of the clinic [i.e. the time in therapeutic range (TTR)] and the clinical outcomes (i.e. the efficacy and safety), and (iii) determine the patients' satisfaction and overall quality of life (QoL).
  
  
  METHODS
  Clinical outcome data were collected through a retrospective chart review of all patients managed from March 2013 to October 2014 at the pharmacist-managed anticoagulation clinic. Furthermore, the patient-oriented outcomes data were prospectively collected using the 24-item Duke Anticoagulation Satisfaction Scale (DASS). Each item was assessed using a 7-point Likert-type scale on which lower scores indicated better QoL and greater satisfaction.
  
  
  CONCLUSIONS
  The clinical outcome data analyses included 119 patients who were enrolled at the clinic during the 19-month study period. The mean number of international normalized ratio (INR) tests/month was 65 ± 9, the average testing frequency was 2·7 ± 1·6 weeks, and the average %TTR was 76·8 ± 22·9%. There was one major bleeding event (0·67%/year), 12 minor bleeding events (8%/year) and two thromboembolic events (1·35%/year) recorded during the study period. Of the 119 patients, 50 participated in the satisfaction and QoL survey. The median (IQR) total QoL score of these subjects was 63 (48) (minimum-maximum achievable score: 24-168). Seventy-six per cent of the patients indicated 'a lot to very much' in terms of their overall satisfaction with the anticoagulation treatment. The participants who were naïve to anticoagulation treatment reported a significantly greater satisfaction and better QoL than the experienced patients [58 (44) vs. 82 (59); P = 0·009].
  
  
  CONCLUSIONS
  These findings provide early evidence that the patients who were managed at a pharmacy-based anticoagulation clinic in an evolving healthcare system experienced optimal anticoagulation management.
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: H F
authors.initials: HF
authors.lastname: Elewa
authors.affiliation: Al-Wakrah Hospital, Hamad Medical Corporation, Al-Wakrah, Qatar.
authors.forename: O
authors.initials: O
authors.lastname: AbdelSamad
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.|Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: A E
authors.initials: AE
authors.lastname: Elmubark
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: H M
authors.initials: HM
authors.lastname: Al-Taweel
authors.affiliation: Al-Wakrah Hospital, Hamad Medical Corporation, Al-Wakrah, Qatar.
authors.forename: A
authors.initials: A
authors.lastname: Mohamed
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: N
authors.initials: N
authors.lastname: Kheir
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: M I
authors.initials: MI
authors.lastname: Mohamed Ibrahim
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: A
authors.initials: A
authors.lastname: Awaisu
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D011446:Prospective Studies; D011780:Qatar; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000925:Anticoagulants
keywords: Qatar; anticoagulation clinic; clinical outcomes; collaborative practice; pharmacist-managed; quality of life; satisfaction; warfarin