Sylvester Katelyn W, Chen Alisia, Lewin Andrea, Fanikos John, Goldhaber Samuel Z, Connors Jean M
Department of Pharmacy Services Brigham and Women's Hospital Boston Massachusetts USA.
Bouve College of Health Sciences Northeastern University Boston Massachusetts USA.
Res Pract Thromb Haemost. 2022 May 5;6(3):e12696. doi: 10.1002/rth2.12696. eCollection 2022 Mar.
In 2017, the Brigham and Women's Hospital Anticoagulation Management Service (BWH AMS) expanded services to patients on direct oral anticoagulants (DOACs). We have since updated our DOAC management plan and adjusted the workflow of our clinic.
This report describes how our DOAC management has evolved and describes key interventions made. Additionally, we report on the results of a survey completed by referring physicians that assessed perspectives regarding centralized DOAC management by BWH AMS pharmacists.
An analysis was completed of all patients referred to the BWH AMS and the number of interventions completed and documented in our anticoagulation management software. A survey with eight questions was sent to 110 referring physicians (selected based on referring to the AMS within the past 1.5 years).
Over 4 years, 1622 patients on DOACs were referred to the BWH AMS, amounting to 3154 DOAC encounters. A total of 212 interventions for medication procurement, 171 dose adjustment interventions, and 603 coordinated procedure plans were completed. Of the 32 physicians who responded to the survey, many believed that the quality and safety of anticoagulation therapy was improved with BWH AMS management. Despite provider satisfaction with pharmacist-led care in DOACs, physicians expressed concerns regarding the lack of provider awareness of the clinic and possible duplicative efforts.
We plan to evolve the DOAC clinic model to optimize its clinical and operational value and to improve our delivery of care using electronic tools to move toward a population management approach for DOAC management.
2017年，布莱根妇女医院抗凝管理服务部（BWH AMS）将服务扩展至使用直接口服抗凝剂（DOAC）的患者。自那时起，我们更新了DOAC管理计划并调整了诊所的工作流程。
本报告描述了我们的DOAC管理如何演变，并介绍了所采取的关键干预措施。此外，我们报告了转诊医生完成的一项调查结果，该调查评估了他们对BWH AMS药剂师集中式DOAC管理的看法。
对所有转诊至BWH AMS的患者以及在我们的抗凝管理软件中完成并记录的干预措施数量进行了分析。向110名转诊医生（根据过去1.5年内转诊至AMS的情况选择）发送了一份包含八个问题的调查问卷。
在4年多的时间里，1622名使用DOAC的患者被转诊至BWH AMS，共计3154次DOAC诊疗。共完成了212次药物采购干预、171次剂量调整干预以及603次协调程序计划。在32名回复调查问卷的医生中，许多人认为BWH AMS管理提高了抗凝治疗的质量和安全性。尽管医生对药剂师主导的DOAC护理感到满意，但他们对诊所缺乏医生认知以及可能存在的重复工作表示担忧。
我们计划改进DOAC诊所模式，以优化其临床和运营价值，并利用电子工具改进我们的护理服务，朝着DOAC管理的人群管理方法迈进。
