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A role for pharmacists in community-based post-discharge warfarin management: protocol for the 'the role of community pharmacy in post hospital management of patients initiated on warfarin' study.

Stafford L, Peterson GM, Bereznicki LR, Jackson SL - BMC Health Serv Res (2011)

Bottom Line: Patient outcomes will be compared to those in a control, or 'usual care', group.Its strengths lie in a strong multidisciplinary team and the utilisation of existing healthcare frameworks.It is hoped that this study will provide the evidence to support the national roll-out of the program as a new Australian professional community pharmacy service.

View Article: PubMed Central - HTML - PubMed

Affiliation: Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia. leanne.stafford@utas.edu.au

ABSTRACT

Background: Shorter periods of hospitalisation and increasing warfarin use have placed stress on community-based healthcare services to care for patients taking warfarin after hospital discharge, a high-risk period for these patients. A previous randomised controlled trial demonstrated that a post-discharge service of 4 home visits and point-of-care (POC) International Normalised Ratio (INR) testing by a trained pharmacist improved patients' outcomes. The current study aims to modify this previously trialled service model to implement and then evaluate a sustainable program to enable the smooth transition of patients taking warfarin from the hospital to community setting.

Methods/design: The service will be trialled in 8 sites across 3 Australian states using a prospective, controlled cohort study design. Patients discharged from hospital taking warfarin will receive 2 or 3 home visits by a trained 'home medicines review (HMR)-accredited' pharmacist in their 8 to 10 days after hospital discharge. Visits will involve a HMR, comprehensive warfarin education, and POC INR monitoring in collaboration with patients' general practitioners (GPs) and community pharmacists. Patient outcomes will be compared to those in a control, or 'usual care', group. The primary outcome measure will be the proportion of patients experiencing a major bleeding event in the 90 days after discharge. Secondary outcome measures will include combined major bleeding and thromboembolic events, death, cessation of warfarin therapy, INR control at 8 days post-discharge and unplanned hospital readmissions from any cause. Stakeholder satisfaction will be assessed using structured postal questionnaire mailed to patients, GPs, community pharmacists and accredited pharmacists at the completion of their study involvement.

Discussion: This study design incorporates several aspects of prior interventions that have been demonstrated to improve warfarin management, including POC INR testing, warfarin education and home visits by trained pharmacists. It faces several potential challenges, including the tight timeframe for patient follow-up in the post-discharge period. Its strengths lie in a strong multidisciplinary team and the utilisation of existing healthcare frameworks. It is hoped that this study will provide the evidence to support the national roll-out of the program as a new Australian professional community pharmacy service.

Trial registration: Australian New Zealand Clinical Trials Registry Number 12608000334303.

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Related in: MedlinePlus

Study model.
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Related In: Results  -  Collection

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Figure 1: Study model.

Mentions: In summary, the post-discharge warfarin management service consists of referral of patients discharged from hospital taking warfarin to, and home follow-up by, a pharmacist in the immediate post-discharge period. Suitable and consenting patients will receive either 2 or 3 home visits by an 'accredited pharmacist', an experienced, mobile pharmacy practitioner, within their first 8 to 10 days post-discharge. The visits will involve a HMR to identify and resolve any post-discharge medication-related issues, warfarin education and the provision of resources depending on the patient's understanding of their warfarin therapy, and POC INR monitoring. The study model is displayed in Figure 1.


A role for pharmacists in community-based post-discharge warfarin management: protocol for the 'the role of community pharmacy in post hospital management of patients initiated on warfarin' study.

Stafford L, Peterson GM, Bereznicki LR, Jackson SL - BMC Health Serv Res (2011)

Study model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3040704&req=5

Figure 1: Study model.
Mentions: In summary, the post-discharge warfarin management service consists of referral of patients discharged from hospital taking warfarin to, and home follow-up by, a pharmacist in the immediate post-discharge period. Suitable and consenting patients will receive either 2 or 3 home visits by an 'accredited pharmacist', an experienced, mobile pharmacy practitioner, within their first 8 to 10 days post-discharge. The visits will involve a HMR to identify and resolve any post-discharge medication-related issues, warfarin education and the provision of resources depending on the patient's understanding of their warfarin therapy, and POC INR monitoring. The study model is displayed in Figure 1.

Bottom Line: Patient outcomes will be compared to those in a control, or 'usual care', group.Its strengths lie in a strong multidisciplinary team and the utilisation of existing healthcare frameworks.It is hoped that this study will provide the evidence to support the national roll-out of the program as a new Australian professional community pharmacy service.

View Article: PubMed Central - HTML - PubMed

Affiliation: Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia. leanne.stafford@utas.edu.au

ABSTRACT

Background: Shorter periods of hospitalisation and increasing warfarin use have placed stress on community-based healthcare services to care for patients taking warfarin after hospital discharge, a high-risk period for these patients. A previous randomised controlled trial demonstrated that a post-discharge service of 4 home visits and point-of-care (POC) International Normalised Ratio (INR) testing by a trained pharmacist improved patients' outcomes. The current study aims to modify this previously trialled service model to implement and then evaluate a sustainable program to enable the smooth transition of patients taking warfarin from the hospital to community setting.

Methods/design: The service will be trialled in 8 sites across 3 Australian states using a prospective, controlled cohort study design. Patients discharged from hospital taking warfarin will receive 2 or 3 home visits by a trained 'home medicines review (HMR)-accredited' pharmacist in their 8 to 10 days after hospital discharge. Visits will involve a HMR, comprehensive warfarin education, and POC INR monitoring in collaboration with patients' general practitioners (GPs) and community pharmacists. Patient outcomes will be compared to those in a control, or 'usual care', group. The primary outcome measure will be the proportion of patients experiencing a major bleeding event in the 90 days after discharge. Secondary outcome measures will include combined major bleeding and thromboembolic events, death, cessation of warfarin therapy, INR control at 8 days post-discharge and unplanned hospital readmissions from any cause. Stakeholder satisfaction will be assessed using structured postal questionnaire mailed to patients, GPs, community pharmacists and accredited pharmacists at the completion of their study involvement.

Discussion: This study design incorporates several aspects of prior interventions that have been demonstrated to improve warfarin management, including POC INR testing, warfarin education and home visits by trained pharmacists. It faces several potential challenges, including the tight timeframe for patient follow-up in the post-discharge period. Its strengths lie in a strong multidisciplinary team and the utilisation of existing healthcare frameworks. It is hoped that this study will provide the evidence to support the national roll-out of the program as a new Australian professional community pharmacy service.

Trial registration: Australian New Zealand Clinical Trials Registry Number 12608000334303.

Show MeSH
Related in: MedlinePlus