Ingram Samantha J, Kirkdale Charlotte L, Williams Sian, Hartley Elaine, Wintle Susan, Sefton Valerie, Thornley Tracey
Boots UK Ltd, Thane Road, Beeston, Nottingham, UK.
School of Pharmacy & Biomolecular Science, University of Brighton, Brighton, UK.
BMC Health Serv Res. 2018 Feb 7;18(1):91. doi: 10.1186/s12913-018-2901-8.
As part of the NHS desire to move services closer to where people live, and provide greater accessibility and convenience to patients, Brighton and Hove Clinical Commissioning Group (CCG) underwent a review of their anticoagulation services during 2008. The outcome was to shift the initiation and monitoring service in secondary care for non-complex patients, including domiciliary patients, into the community. This was achieved via a procurement process in 2008 resulting in the Community Pharmacy Anticoagulation Management Service (CPAMs) managed by Boots UK (a large chain of community pharmacies across the United Kingdom).
This evaluation aims to review the outcomes (International Normalised Ratio [INR] readings) and experiences of those patients attending the anticoagulation monitoring service provided by community pharmacists in Brighton and Hove. All patients on warfarin are given a target INR range they need to achieve; dosing of and frequency of appointment are dependent on the INR result. Outcome measures for patients on the CPAM service included percentage INR readings that were within target range and the percentage time the patient was within therapeutic range. Data collected from 2009 to 2016 were analysed and results compared to the service targets. Patient experience of the service was evaluated via a locally developed questionnaire that was issued to patients annually in the pharmacy.
The evaluation shows that community pharmacy managed anticoagulation services can achieve outcomes at a level consistently exceeding national and local targets for both percentage INR readings in therapeutic target range (65.4%) compared to the recommended minimum therapeutic target range of 60.0% and percentage time in therapeutic range (72.5%, CI 71.9-73.1%) compared to the national target of 70.0%. Patients also indicated they were satisfied with the service, with over 98.6% patients rating the service as good, very good or excellent.
The Brighton and Hove CPAM service achieved above average national target management of INR and positive patient feedback, demonstrating that community pharmacy is ideally placed to provide this service safely and deliver enhanced clinical outcomes and positive patient experience.
作为英国国家医疗服务体系（NHS）将服务向民众居住地靠近、为患者提供更高可及性和便利性这一愿景的一部分，布莱顿和霍夫临床委托小组（CCG）在2008年对其抗凝服务进行了审查。审查结果是将非复杂患者（包括居家患者）在二级医疗中的起始和监测服务转移至社区。这一目标通过2008年的采购流程得以实现，最终形成了由博姿英国公司（一家遍布英国的大型社区药房连锁企业）管理的社区药房抗凝管理服务（CPAMs）。
本评估旨在审查布莱顿和霍夫社区药剂师提供的抗凝监测服务中患者的治疗结果（国际标准化比值[INR]读数）及体验。所有服用华法林的患者都被设定了需要达到的目标INR范围；用药剂量和预约频率取决于INR结果。CPAM服务患者的结果指标包括INR读数在目标范围内的百分比以及患者处于治疗范围内的时间百分比。对2009年至2016年收集的数据进行了分析，并将结果与服务目标进行了比较。通过在药房每年向患者发放的本地编制问卷来评估患者对该服务的体验。
评估表明，社区药房管理的抗凝服务在治疗目标范围内的INR读数百分比（65.4%）方面，与推荐的最低治疗目标范围60.0%相比，以及在治疗范围内的时间百分比（72.5%，置信区间71.9 - 73.1%）方面，与国家目标70.0%相比，均能始终如一地达到超过国家和地方目标的水平。患者还表示他们对该服务感到满意，超过98.6%的患者将该服务评为良好、非常好或优秀。
布莱顿和霍夫的CPAM服务在INR管理方面达到了高于全国平均水平的目标，并获得了患者的积极反馈，表明社区药房非常适合安全地提供此项服务，并能带来更好的临床结果和积极的患者体验。
