Evaluation of 4 years of clinical pharmacist anticoagulation case management in a rural, private physician office.

OBJECTIVES

To evaluate patient outcomes after 4 years of anticoagulation case management by a pharmacist and to document patient and provider satisfaction with the service.

SETTING

Rural, private physician office in Mt. Vernon, Iowa.

PRACTICE DESCRIPTION

Clinical pharmacist anticoagulation clinic.

PRACTICE INNOVATION

Under a protocol reviewed annually, a clinical pharmacist faculty member from the University of Iowa College of Pharmacy provides on-site, point-of-care anticoagulation dose adjustment and monitoring 1 day per week.

MAIN OUTCOME MEASURES

Data on anticoagulation outcomes from 1998 to 2002 were obtained through retrospective review of medical charts of patients served by the clinic. A survey of patient satisfaction with the clinic was mailed to all currently active patients enrolled in the anticoagulation clinic, and a second satisfaction survey was distributed to providers and ancillary staff of the physician office.

RESULTS

Eighty patients met the criteria for evaluation of therapeutic outcomes. The mean +/- standard deviation percentage of international normalized ratios in the therapeutic range ("percent therapeutic") for the anticoagulation clinic population was 57.5 +/- 17.4. The percent therapeutic for patients who had been on warfarin before enrolling in the pharmacist case management anticoagulation clinic (defined as the usual medical care group) was 37.6%, compared with 57.8% for those patients receiving care in the pharmacist case management anticoagulation clinic (P < .001). In nearly all instances, responses to the surveys indicated that patient and provider satisfaction with the anticoagulation service was extremely high.

CONCLUSION

A clinical pharmacist can provide anticoagulation case management services safely and effectively in a private physician office, and the service is highly valued by both patients and providers. We believe case management is an optimal method for systematically monitoring outpatient anticoagulation therapies and is preferable to usual medical care.