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Impact of a pharmacist intervention on DOAC knowledge and satisfaction in ambulatory patients

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Abstract

Patient education of high-risk medications such as direct oral anticoagulants (DOACs) is limited in ambulatory care settings. Clinical pharmacists are uniquely equipped to educate patients about DOACS but seldom interact with patients in those settings where patient education and satisfaction are often overlooked. Recently, the Anticoagulation Forum endorsed a checklist (DOAC Checklist) to guide and educate patients initiating or resuming DOACs. We assessed the impact on knowledge and satisfaction of an intervention framed around the checklist. Randomized clinical trial. Ambulatory patients starting a DOAC or resuming one after setback (bleeding, stroke, or transient ischemic attack) in an ambulatory setting (office, emergency department, or short stay hospitalization). Three educational clinical pharmacist tele-visits, hotline access to the pharmacist, and coordination with continuity providers in 3 months. Patient knowledge scores from a 15-item DOAC-related questionnaire and satisfaction scores from an abbreviated version of the Duke Anticoagulation Satisfaction Survey (DASS). Of 561 randomized patients, 436 completed our follow-up surveys. Knowledge scores were similar for the 233 intervention patients vs. 203 control patients (63.7% vs 62.2% correct). Satisfaction scores on the 7-point Likert scale were virtually identical (6.24 and 6.22). Our pharmacist-led intervention framed around the DOAC checklist had little impact on knowledge and satisfaction. Delays between intervention end and completion of the follow-up questionnaires may have obscured benefits experienced earlier. More intensive education or strategies other than telephone-based consultation may be required to produce sustained knowledge.

TRN: NCT04068727 retrospectively registered on August 22, 2019.

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Acknowledgements

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Funding

This study was funded by Grant #R18HS026859 from the Agency for Healthcare Research and Quality (AHRQ).

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Authors and Affiliations

  1. Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA

    Thu Pham, Parth Patel, Daniel Mbusa, Alok Kapoor, Sybil Crawford, Hammad Sadiq, Sanjeev Rampam, Joann Wagner, Jerry H. Gurwitz & Kathleen M. Mazor

  2. Reliant Medical Group, Worcester, MA, USA

    Jerry H. Gurwitz

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  1. Thu Pham
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  2. Parth Patel
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  3. Daniel Mbusa
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  9. Jerry H. Gurwitz
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  10. Kathleen M. Mazor
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Correspondence to Alok Kapoor.

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Conflicts of interest

Alok Kapoor has received grant support through a competitive process adjudicated and funded by the alliance formed by both Pfizer and Bristol-Myers Squibb. He has also been awarded a grant by Pfizer to examine conversations between patients and providers. Jerry Gurwitz is a consultant of United HealthCare.

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The Institutional Review Board at the University of Massachusetts Chan Medical School approved this study; we obtained informed consent from all participants.

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The Institutional Review Board at the University of Massachusetts Chan Medical School approved this study; we obtained informed consent from all participants.

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Pham, T., Patel, P., Mbusa, D. et al. Impact of a pharmacist intervention on DOAC knowledge and satisfaction in ambulatory patients. J Thromb Thrombolysis 55, 346–354 (2023). https://doi.org/10.1007/s11239-022-02743-0

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