title: Advantages of a Warfarin Protocol for Long-term Care Pharmacists: a Retrospective Cohort Study.
abstract: BACKGROUND
  Warfarin is an anticoagulant prescribed to 12% of long-term care residents to reduce the risk of thrombo-embolism. This study used indicators to compare warfarin management by pharmacists to usual care.
  
  
  METHODS
  This was a retrospective cohort study comparing a pharmacist-managed warfarin protocol with usual care of qualified warfarin recipients at long-term care facilities (two protocol, one control) in Calgary, Alberta. We compared the proportion of international normalized ratio (INR) tests in the range 2.0 to 3.0, time in range, number of tests, and frequency of bleeding at protocol and control sites. Our primary outcome, time in INR therapeutic range, is an indicator for assuring care quality. A cross-sectional survey at these sites compared health professionals' perceptions of workload and effectiveness of warfarin management.
  
  
  RESULTS
  Of the 197 residents' charts reviewed in the study period, those on protocol had 45.0 INR tests while those on usual care had 52.7 tests (p = .034, 95% CI for the difference: 0.6 to 14.6 INR tests). No significant difference was found for time in therapeutic range, number of tests in range, or major bleeding events. Of 178 health professionals surveyed, those from protocol facilities were more satisfied with warfarin management (p = .013). Workload and safety were perceived similarly at all sites.
  
  
  CONCLUSIONS
  Our results suggest that a pharmacist-managed warfarin protocol is as effective as usual care and has advantages pertaining to work satisfaction, knowledge of drug interactions, consistent documentation, and fewer INR tests. Further research on teamwork and coagulation management in long-term care facilities is recommended.
authors.affiliation: Family Medicine and Primary Care Research Office, Cumming School of Medicine, University of Calgary, Calgary;; Integrated Supportive and Facility Living, Alberta Health Services, Calgary;; Southern Alberta Primary Care Research Network, University of Calgary, Calgary;
authors.forename: Randall
authors.initials: R
authors.lastname: Sargent
authors.affiliation: Pharmacy Services, Alberta Health Services, Edmonton;
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brocklebank
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary;
authors.forename: Helen
authors.initials: H
authors.lastname: Tam-Tham
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary;
authors.forename: Tyler
authors.initials: T
authors.lastname: Williamson
authors.affiliation: Integrated Supportive and Facility Living, Alberta Health Services, Calgary;; Southern Alberta Primary Care Research Network, University of Calgary, Calgary;
authors.forename: Patrick
authors.initials: P
authors.lastname: Quail
authors.affiliation: Integrated Supportive and Facility Living, Alberta Health Services, Calgary;; Carewest, Calgary;
authors.forename: Diana
authors.initials: D
authors.lastname: Turner
authors.affiliation: Department of Family Medicine and Dentistry, University of Alberta, Edmonton, Alberta.
authors.forename: Neil
authors.initials: N
authors.lastname: Drummond
keywords: anticoagulation; continuing care; international normalized ratio (INR); pharmacy; protocol; warfarin