Kim Jennifer J, Hill Hailey L, Groce James B, Granfortuna James M, Makhlouf Tanya K
1 Greensboro Area Health Education Center, Greensboro, NC, USA.
2 Cone Health, Greensboro, NC, USA.
J Pharm Pract. 2018 Oct;31(5):462-468. doi: 10.1177/0897190017752713. Epub 2018 Jan 24.
Best practice recommendations are lacking. Thus far, literature has described pharmacist-led DOAC monitoring.
The purpose of this study is to describe a DOAC monitoring program involving pharmacy students.
This was an observational analysis of a quality improvement initiative. A clinical pharmacist preceptor identified clinic patients taking DOACs by running a report using the electronic medical record. Pharmacy students conducted chart reviews, called pharmacies for 6-month refill histories, and interviewed and educated patients. Findings were communicated to the care team and interventions were performed as applicable with the preceptor.
Of 90 patients included, the mean age was 63 years, 54% were female, and 65.6% were black or African American. Rivaroxaban and apixaban were used most commonly. Sixty-two percent of DOACs were prescribed for atrial fibrillation/flutter, while 32.2% for venous thromboembolism. The mean MPR was 77.1%, with 27.7% of patients having an MPR ≤60%. Of the 136 student-led interventions, 25.2% involved medication access, 24.4% adherence education, 20.7% processing refills, 14.8% laboratory monitoring recommendations, 8.9% switching or recommending switching to another anticoagulant, and 4.4% stopping a nonsteroidal anti-inflammatory drug or aspirin.
Pharmacy students can help to ensure medication safety and effective use of DOACs.
缺乏最佳实践建议。到目前为止，文献中已经描述了由药剂师主导的直接口服抗凝剂（DOAC）监测。
本研究的目的是描述一个涉及药学专业学生的DOAC监测项目。
这是一项对质量改进计划的观察性分析。临床药师带教老师通过使用电子病历运行报告来识别正在服用DOAC的门诊患者。药学专业学生进行病历审查，致电药房获取6个月的续方记录，并对患者进行访谈和教育。研究结果传达给护理团队，并在带教老师的指导下进行适当的干预。
纳入的90例患者中，平均年龄为63岁，54%为女性，65.6%为黑人或非裔美国人。利伐沙班和阿哌沙班使用最为普遍。62%的DOAC用于心房颤动/扑动，而32.2%用于静脉血栓栓塞。平均药物持有率（MPR）为77.1%，27.7%的患者MPR≤60%。在136项由学生主导的干预措施中，25.2%涉及药物获取，24.4%涉及依从性教育，20.7%涉及处理续方，14.8%涉及实验室监测建议，8.9%涉及更换或建议更换为另一种抗凝剂，4.4%涉及停用非甾体抗炎药或阿司匹林。
药学专业学生可以帮助确保药物安全和DOAC的有效使用。
