Evaluation of a pharmacist-led outpatient direct oral anticoagulant service.
OBJECTIVE
The impact of a pharmacist-led direct oral anticoagulant (DOAC) service on prescription appropriateness and patient adherence was simultaneously evaluated.


METHODS
In this retrospective analysis, patients age 18 years or older for whom a DOAC was prescribed from September 20, 2013, through December 31, 2014, were identified through electronic medical record review of all DOAC prescriptions within the University of Michigan Health System. Patients had their DOAC therapy managed by a pharmacist-led DOAC service or by their physician (usual care). Primary endpoints included the percentage of patients who had appropriate DOAC therapy prescribed at baseline and at follow-up appointments at 3-6 months. Secondary endpoints included mean medication possession ratios (MPRs).


RESULTS
A total of 258 patients were included in the study, with 129 in each group. Patients in the pharmacist-led DOAC service were significantly more likely to have an appropriate combination of DOAC and dosage prescribed for their indication at baseline compared with the usual care group (p= 0.009), a finding that persisted at follow up (p= 0.016). There was no significant difference between groups in the number of patients determined to have an appropriate DOAC prescribed for an approved indication (independent of dose) in the pharmacist-led service (95.3%) versus usual care (93.0%) at baseline. Patients in the pharmacist-led service had a greater mean adjusted MPR compared with the usual care group (p= 0.0014) over a median follow-up period of 248 days.


CONCLUSIONS
A pharmacist-led DOAC service increased appropriate dosing of DOACs at baseline and follow up as well as patient adherence to therapy.
University of Michigan Health System, Ann Arbor, MI. eashjian@med.umich.edu.
Emily
E
Ashjian
University of Michigan Health System, Ann Arbor, MI.
Brian
B
Kurtz
University of Michigan Health System, Ann Arbor, MI.
Elizabeth
E
Renner
University of Michigan College of Pharmacy, Ann Arbor, MI.
Robert
R
Yeshe
Frankel Cardiovascular Center and Institute for Health Policy and Innovation, University of Michigan Health System, Ann Arbor, MI.
Geoffrey D
GD
Barnes
D000284:Administration, Oral; D000368:Aged; D000553:Ambulatory Care / Q000379:methods / Q000458:organization & administration*; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000517:prevention & control; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D010595:Pharmacists / Q000458:organization & administration*; D024382:Professional Role; D015397:Program Evaluation; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000517:prevention & control; D016903:Drug Monitoring
D000925:Anticoagulants
DOAC; anticoagulant; apixaban; dabigatran; drug monitoring; rivaroxaban