Epplen Kelly, Dusing-Wiest Michelle, Freedlund Joanna, Harger Nicole, Kathman Susan, Ivey Marianne F
Ambulatory Care Pharmacy Services, Health Alliance, Florence, KY 41042, USA.
Am J Health Syst Pharm. 2007 May 1;64(9):945-51. doi: 10.2146/ajhp060009.
A methodological approach was developed to facilitate expansion of clinical pharmacist-managed anticoagulation services across an integrated health care delivery network.
A stepwise approach to the development and implementation of ambulatory care clinical pharmacy services was used to facilitate expansion of pharmacist-managed anticoagulation clinics in a university hospital setting and a community hospital within the same health network.
The Health Alliance of Greater Cincinnati successfully created a care delivery model using clinical pharmacists to provide comprehensive anticoagulation management services at a university hospital and a community hospital. The incidence of thromboembolic events was significantly lower in the pharmacy anticoagulation service patients versus the patients in the usual care setting (p=0.005). A statistically significant decrease in minor bleeding events was observed in the pharmacist-managed group (p=0.038). Although a decrease in major bleeding events was observed, it was not statistically significant (p=0.075). International Normalized Ratio values of the patients managed by the pharmacy anticoagulation clinics were within the therapeutic range approximately 75% of the time.
A stepwise approach to the development and implementation of ambulatory care clinical pharmacy services has facilitated the expansion of pharmacist-managed anticoagulation clinics across an integrated health system. This may serve as a valuable template for other systems as they strive to develop medication therapy management services.
开发一种方法，以促进临床药师管理的抗凝服务在综合医疗服务网络中的扩展。
采用逐步推进门诊护理临床药学服务开发与实施的方法，促进同一医疗网络内大学医院和社区医院中药师管理的抗凝门诊的扩展。
大辛辛那提健康联盟成功创建了一种护理模式，利用临床药师在大学医院和社区医院提供全面的抗凝管理服务。与常规护理组患者相比，接受药学抗凝服务的患者血栓栓塞事件发生率显著更低（p = 0.005）。在药师管理组中，轻微出血事件有统计学意义的下降（p = 0.038）。虽然观察到严重出血事件有所下降，但无统计学意义（p = 0.075）。药学抗凝门诊管理的患者的国际标准化比值约75%的时间处于治疗范围内。
逐步推进门诊护理临床药学服务的开发与实施，促进了药师管理的抗凝门诊在综合医疗系统中的扩展。这可能为其他致力于开发药物治疗管理服务的系统提供有价值的模板。
