Optimization of DOAC management services in a centralized anticoagulation clinic.
anticoagulant
burnout
clinical pharmacy services
direct‐acting oral anticoagulant
quality improvement
Journal
Research and practice in thrombosis and haemostasis
ISSN: 2475-0379
Titre abrégé: Res Pract Thromb Haemost
Pays: United States
ID NLM: 101703775
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
03
12
2021
revised:
08
02
2022
accepted:
02
03
2022
entrez:
11
5
2022
pubmed:
12
5
2022
medline:
12
5
2022
Statut:
epublish
Résumé
In 2017, the Brigham and Women's Hospital Anticoagulation Management Service (BWH AMS) expanded services to patients on direct oral anticoagulants (DOACs). We have since updated our DOAC management plan and adjusted the workflow of our clinic. This report describes how our DOAC management has evolved and describes key interventions made. Additionally, we report on the results of a survey completed by referring physicians that assessed perspectives regarding centralized DOAC management by BWH AMS pharmacists. An analysis was completed of all patients referred to the BWH AMS and the number of interventions completed and documented in our anticoagulation management software. A survey with eight questions was sent to 110 referring physicians (selected based on referring to the AMS within the past 1.5 years). Over 4 years, 1622 patients on DOACs were referred to the BWH AMS, amounting to 3154 DOAC encounters. A total of 212 interventions for medication procurement, 171 dose adjustment interventions, and 603 coordinated procedure plans were completed. Of the 32 physicians who responded to the survey, many believed that the quality and safety of anticoagulation therapy was improved with BWH AMS management. Despite provider satisfaction with pharmacist-led care in DOACs, physicians expressed concerns regarding the lack of provider awareness of the clinic and possible duplicative efforts. We plan to evolve the DOAC clinic model to optimize its clinical and operational value and to improve our delivery of care using electronic tools to move toward a population management approach for DOAC management.
Sections du résumé
Background
UNASSIGNED
In 2017, the Brigham and Women's Hospital Anticoagulation Management Service (BWH AMS) expanded services to patients on direct oral anticoagulants (DOACs). We have since updated our DOAC management plan and adjusted the workflow of our clinic.
Objectives
UNASSIGNED
This report describes how our DOAC management has evolved and describes key interventions made. Additionally, we report on the results of a survey completed by referring physicians that assessed perspectives regarding centralized DOAC management by BWH AMS pharmacists.
Methods
UNASSIGNED
An analysis was completed of all patients referred to the BWH AMS and the number of interventions completed and documented in our anticoagulation management software. A survey with eight questions was sent to 110 referring physicians (selected based on referring to the AMS within the past 1.5 years).
Results
UNASSIGNED
Over 4 years, 1622 patients on DOACs were referred to the BWH AMS, amounting to 3154 DOAC encounters. A total of 212 interventions for medication procurement, 171 dose adjustment interventions, and 603 coordinated procedure plans were completed. Of the 32 physicians who responded to the survey, many believed that the quality and safety of anticoagulation therapy was improved with BWH AMS management. Despite provider satisfaction with pharmacist-led care in DOACs, physicians expressed concerns regarding the lack of provider awareness of the clinic and possible duplicative efforts.
Conclusion
UNASSIGNED
We plan to evolve the DOAC clinic model to optimize its clinical and operational value and to improve our delivery of care using electronic tools to move toward a population management approach for DOAC management.
Identifiants
pubmed: 35541695
doi: 10.1002/rth2.12696
pii: S2475-0379(22)01189-X
pmc: PMC9069544
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e12696Informations de copyright
© 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).
Références
Blood. 2020 Mar 5;135(10):724-734
pubmed: 31951652
Res Pract Thromb Haemost. 2018 Dec 12;3(1):136-137
pubmed: 30656287
J Manag Care Spec Pharm. 2021 Sep;27(9):1210-1220
pubmed: 34464214
J Clin Oncol. 2020 Feb 10;38(5):496-520
pubmed: 31381464
J Pharm Pract. 2020 Jun;33(3):271-275
pubmed: 30213217
Res Pract Thromb Haemost. 2022 May 05;6(3):e12696
pubmed: 35541695
J Thromb Thrombolysis. 2018 Feb;45(2):274-280
pubmed: 29274044
JAMA. 2015 Apr 14;313(14):1443-50
pubmed: 25871670
Int J Clin Pharm. 2018 Jun;40(3):721-729
pubmed: 29605947
Circ Cardiovasc Qual Outcomes. 2016 Mar;9(2):182-5
pubmed: 26933047
JAMA. 2016 Nov 22;316(20):2115-2125
pubmed: 27893129
JAMA Intern Med. 2018 Oct 1;178(10):1317-1331
pubmed: 30193239
Chest. 2018 Nov;154(5):1121-1201
pubmed: 30144419
Healthcare (Basel). 2021 Oct 01;9(10):
pubmed: 34682992
Am J Health Syst Pharm. 2017 Apr 1;74(7):483-489
pubmed: 28336758
Chest. 2016 Feb;149(2):315-352
pubmed: 26867832
J Am Heart Assoc. 2021 Dec 21;10(24):e022758
pubmed: 34796718
Lancet. 2016 Nov 5;388(10057):2272-2281
pubmed: 27692469
Res Pract Thromb Haemost. 2018 Oct 19;3(1):79-84
pubmed: 30656279
Circ Cardiovasc Qual Outcomes. 2020 Mar;13(3):e005969
pubmed: 32148102
Nephron. 1976;16(1):31-41
pubmed: 1244564
J Thromb Thrombolysis. 2016 Jan;41(1):206-32
pubmed: 26780747
Ann Pharmacother. 2014 Oct;48(10):1258-68
pubmed: 24982310
Pharmacotherapy. 2017 Oct;37(10):1284-1297
pubmed: 28730690
J Thromb Thrombolysis. 2022 Feb;53(2):436-445
pubmed: 34410560
Arch Intern Med. 2012 Oct 8;172(18):1377-85
pubmed: 22911330
N Engl J Med. 2009 Apr 2;360(14):1418-28
pubmed: 19339721
J Emerg Med. 2017 Dec;53(6):896-903
pubmed: 28941557
J Thromb Thrombolysis. 2021 May;51(4):1050-1058
pubmed: 33037531
Circulation. 2019 Jul 9;140(2):e125-e151
pubmed: 30686041