Garwood Candice L, Dumo Peter, Baringhaus Stephanie N, Laban Kristyn M
Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan 48201, USA.
Pharmacotherapy. 2008 Jan;28(1):20-6. doi: 10.1592/phco.28.1.20.
To determine if transitioning patients from a pharmacist- managed anticoagulation clinic after stabilization of warfarin therapy to physician-managed care alters the quality of anticoagulation care.
Retrospective medical record review.
Pharmacist-managed, urban academic medical center-based outpatient anticoagulation clinic.
Forty patients who were stabilized on warfarin therapy.
Quality of anticoagulation care was measured by percentage of international normalized ratios (INRs) in target range, anticoagulation-related health care visits, and responses to satisfaction surveys. A significant decrease in anticoagulation control was observed on transition to physician-managed care. Before transition, 76% of all INRs were in target range versus 48% after transition (p<0.0001, chi(2) test). When performing paired analysis, a median 75% of each patient's INRs were therapeutic before transition compared with 36.5% after (p<0.0001, Wilcoxon signed rank test). Thirty-two percent of first INR values measured after transition from the clinic were in target range, and the median time to first follow-up INR was 41 days. The number of INR values above 4.5 and below 1.5 increased significantly after transition from the anticoagulation clinic (p<0.0001 and p=0.01, respectively, chi(2) test). Before transition from the anticoagulation clinic, two anticoagulation-related emergency department visits were reported in one patient. After transition, 13 cases of additional medical care were reported among seven patients; seven of the 13 cases required an office visit with the physician, and six resulted in emergency room evaluation. None of these cases resulted in hospitalization. Patient satisfaction with clinical care provided by the anticoagulation clinic was significantly higher before transition.
Transition of patients from a pharmacist-managed anticoagulation clinic back to physician-managed anticoagulation care after stabilization of warfarin therapy was associated with a significant decrease in INR control, increased medical care related to anticoagulation, and decreased patient satisfaction.
确定在华法林治疗稳定后，将患者从药剂师管理的抗凝门诊转至医生管理的护理模式是否会改变抗凝治疗的质量。
回顾性病历审查。
基于城市学术医疗中心的由药剂师管理的门诊抗凝诊所。
40名华法林治疗稳定的患者。
抗凝治疗质量通过国际标准化比值（INR）处于目标范围的百分比、与抗凝相关的医疗就诊次数以及满意度调查的回复情况来衡量。转至医生管理的护理模式后，观察到抗凝控制显著下降。转之前，所有INR的76%处于目标范围，而转之后为48%（p<0.0001，卡方检验）。进行配对分析时，每位患者转之前INR的中位数有75%为治疗性，而转之后为36.5%（p<0.0001，Wilcoxon符号秩检验）。从诊所转出后首次测量的INR值有32%处于目标范围，首次随访INR的中位时间为41天。从抗凝门诊转出后，INR值高于4.5和低于1.5的数量显著增加（分别为p<0.0001和p=0.01，卡方检验）。在从抗凝门诊转出之前，有一名患者报告了两次与抗凝相关的急诊就诊。转出后，7名患者报告了另外13例医疗护理情况；13例中有7例需要去医生办公室就诊，6例导致了急诊室评估。这些病例均未导致住院。患者对抗凝门诊提供的临床护理的满意度在转之前显著更高。
在华法林治疗稳定后，将患者从药剂师管理的抗凝门诊转回医生管理的抗凝护理模式与INR控制显著下降、与抗凝相关的医疗护理增加以及患者满意度降低有关。
