Harper Paul, McMichael Ian, Griffiths Dale, Harper Joe, Hill Claire
Clinical Haematology, Palmerston North Hospital, Palmerston North, New Zealand.
N Z Med J. 2015 Sep 25;128(1422):31-41.
To ensure that the Community Pharmacy-Based Anticoagulation Management Service (CPAMS) in New Zealand has continued to deliver a high standard of anticoagulant care as the service has grown to provide warfarin supervision to over 4,000 patients.
A clinical audit of patients managed through CPAMS over two years from 1 January, 2013. Anticoagulant control was assessed by measuring the time in therapeutic range (TTR), proportion of high and low INR results and incidence of reported bleeds. Compliance with the service was evaluated by monitoring the frequency of testing and the interval between tests.
There has been only a modest change in the TTR from 76.4% to 74% during the audit period, despite the growth in patient numbers from 850 to 4,350. There was no change in the proportion of INR results above 4.0. Bleeding was reported in less than 4% of visits and 82% of bleeds were minor. 75% of patients attended for INR testing on the expected date, and only 3.3% were more than 2 weeks overdue. The interval between tests remained constant at approximately 19 days.
CPAMS provides safe reliable anticoagulant care with a consistently high level of anticoagulant control.
随着新西兰社区药房抗凝管理服务（CPAMS）发展到为4000多名患者提供华法林监测，确保该服务持续提供高标准的抗凝护理。
对2013年1月1日起两年内通过CPAMS管理的患者进行临床审计。通过测量治疗范围内的时间（TTR）、高低INR结果的比例以及报告的出血发生率来评估抗凝控制情况。通过监测检测频率和检测间隔来评估对该服务的依从性。
在审计期间，尽管患者人数从850增加到4350，但TTR仅从76.4%有适度变化至74%。INR结果高于4.0的比例没有变化。不到4%的就诊报告有出血，且82%的出血为轻微出血。75%的患者在预期日期进行INR检测，只有3.3%的患者逾期超过两周。检测间隔保持在约19天不变。
CPAMS提供安全可靠的抗凝护理，抗凝控制水平持续较高。
