Dib Jean G, Mohammed Khurram, Momattin Hisham I, Alshehri Ali M
Senior Pharmacy Supervisor, Pharmacy Services Division, Johns Hopkins Aramco Healthcare (previously known as Saudi Aramco Medical Services Organization) , Dhahran, Saudi Arabia.
Chief Pharmacist, Pharmacy Services Division, Johns Hopkins Aramco Healthcare (previously known as Saudi Aramco Medical Services Organization) , Dhahran, Saudi Arabia.
Hosp Pharm. 2014 Mar;49(3):260-8. doi: 10.1310/hpj4903-260.
During the past 2 decades, a paradigm shift in the management of oral anticoagulation therapy has occurred. A multidisciplinary approach has been used and has proved beneficial from both a cost and quality perspective. However, this approach to anticoagulation therapy is not well established in Saudi Arabia and the Middle East, and the traditional way of managing anticoagulation patients is still the mainstay of care. The Pharmacy Services Division (PSD) in collaboration with physician, nursing, and medical support enterprises at the Dhahran Health Center established the pharmacy-managed anticoagulation clinic (ACC).
To describe the implementation process of the first pharmacist-managed anticoagulation clinic in the eastern province of Saudi Arabia and its impact on patient care.
The PSD in collaboration with medical staff successfully created a care delivery model utilizing clinical pharmacists' expertise to provide comprehensive anticoagulation management services at Saudi Aramco Medical Services Organization (SAMSO). Planning included analyzing existing practices, reviewing the relevant literature, obtaining physician input, formulating a business proposal, and developing clinical protocols and guidelines. Collaborative relationships were established with the center laboratory, scheduling services, and nursing and medical departments. Clinic services include patient assessment, anticoagulation monitoring, warfarin dosage adjustment, medication dispensing at the clinic, patient education, and feedback to referring physicians. Data (2 years before and after clinic inception) for all patients enrolled at the anticoagulation clinic were reviewed to evaluate the impact of the clinic on anticoagulation management, adverse events, and patient satisfaction.
A total of 578 patients were enrolled in the ACC. The total percentage of international normalized ratio (INR) within the target range was 59% versus 48% when compared to the previous traditional practice. The number of INR tests per patient dropped by 19%. Minor and major adverse events occurred in 10% and 1.5% of patients, respectively. Overall, the patients were very satisfied with the new clinic compared to the previous practice.
Implementation of the pharmacist-managed ACC in the eastern province of Saudi Arabia had a positive impact on patient care based on the improvements in the number of patients whose INR was within therapeutic range and patient satisfaction scores.
在过去20年中，口服抗凝治疗管理发生了范式转变。多学科方法已被采用，并且从成本和质量角度来看都已证明是有益的。然而，这种抗凝治疗方法在沙特阿拉伯和中东地区尚未得到充分确立，管理抗凝患者的传统方式仍然是护理的主要支柱。达兰健康中心的药学服务部（PSD）与医生、护理和医疗支持企业合作，设立了由药房管理的抗凝诊所（ACC）。
描述沙特阿拉伯东部省份首个由药剂师管理的抗凝诊所的实施过程及其对患者护理的影响。
PSD与医务人员合作，成功创建了一种护理模式，利用临床药剂师的专业知识在沙特阿美医疗服务组织（SAMSO）提供全面的抗凝管理服务。规划包括分析现有做法、查阅相关文献、征求医生意见、制定商业提案以及制定临床方案和指南。与中心实验室、排班服务以及护理和医疗部门建立了合作关系。诊所服务包括患者评估、抗凝监测、华法林剂量调整、诊所内配药、患者教育以及向转诊医生反馈。回顾了抗凝诊所所有登记患者的数据（诊所设立前后各2年），以评估诊所对抗凝管理、不良事件和患者满意度的影响。
共有578名患者登记到ACC。与之前的传统做法相比，国际标准化比值（INR）在目标范围内的总百分比为59%，而之前为48%。每位患者的INR检测次数减少了19%。分别有10%和1.5%的患者发生了轻微和严重不良事件。总体而言，与之前的做法相比，患者对新诊所非常满意。
基于INR处于治疗范围内的患者数量增加以及患者满意度得分提高，在沙特阿拉伯东部省份实施由药剂师管理的ACC对患者护理产生了积极影响。
