Chest
Clinical InvestigationsEffect of a Centralized Clinical Pharmacy Anticoagulation Service on the Outcomes of Anticoagulation Therapy
Section snippets
Setting
Study subjects were members of the Kaiser Permanente Colorado Region (KPCR), a nonprofit, group-model HMO. The physicians of the Colorado Permanente Medical Group contract exclusively with the Kaiser Foundation Health Plan to provide comprehensive health care to approximately 400,000 plan members. Outpatient medical, radiology, pharmacy, and laboratory services are provided at 16 medical offices throughout the Denver, CO, metropolitan area. Inpatient care is provided by medical group physicians
Study Sample
A total of 7,668 subjects were initially identified for potential study inclusion (Fig 1). One thousand twenty-three patients were excluded, resulting in a total of 6,645 patients who were eligible for inclusion in the final analyses (CPAS group, 3,323 patients; control groups, 3,322 patients). The two groups were similar in age, but the proportion of men was slightly higher in the control group (p = 0.05) [Table 2]. More patients in the control group had a goal INR range other than 2.0 to 3.0
Discussion
The results of this study indicate that a centralized, telephonic, pharmacist-managed AMS improved therapeutic INR control and reduced the risk of anticoagulation therapy-related complications compared to the usual anticoagulation therapy management provided by the patient's physician. The CPAS reduced the risk of experiencing a major bleeding, thromboembolic, or fatal event while receiving anticoagulant therapy by 39% compared to usual care. The absolute risk reduction of the intervention
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Feasibility study of the Fearon Algorithm in anticoagulation service guided warfarin management
2022, Thrombosis UpdateCitation Excerpt :Thus, our study further supports the use of algorithms as an effective tool to improve the quality of warfarin therapy. The observed 10% improvement in corrected TTR is likely to be clinically meaningful as a previous study has demonstrated that a 9% absolute improvement in TTR was associated with a 39% reduction in the risk of experiencing a major bleeding, thromboembolic, or fatal event while receiving warfarin therapy [21]. Existing warfarin dosing algorithms generally suggest a fixed percentage change to the weekly warfarin maintenance dose (e.g. 10%–20%) in response to out-of-range INR results.
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2021, Research and Practice in Thrombosis and HaemostasisComparative effects of telemedicine and face-to-face warfarin management: A systematic review and network meta-analysis
2020, Journal of the American Pharmacists AssociationCitation Excerpt :A total of 11,478 participants were included in the 12 studies, with the mean age ranging from 49.9 years to 70.4 years (Table 1). Telemedicine among the included studies can be classified into 5 main types on the basis of a combination of 1 of each of these 3 domains: method of INR testing; procedure and method for communicating follow-up; and personnel who communicated the recommended dosage adjustment (Appendix 2): 1) laboratory draw with individual telephonic follow-up by HC provider (Lab/Tel/HC);24,26,27,29,33-35 2) laboratory draw with individual telephonic follow-up and periodic, routine F2F visit (Lab/Tel+F2F/HC);32 3) laboratory draw with individual and group follow-up by HC provider via online e-mail, chat, or messaging accessed on preferred device (Lab/Online/HC);25 4) PST with telephonic or Web-based follow-up by automated management system (PST/Tel-Online/Auto);28,30,31 and 5) PST with telephonic follow-up by HC provider (PST/Tel/HC)29 (Appendix 3). The study by Lee et al.29 divided patients into 3 groups: 1) F2F; 2) Lab/Tel/HC; and 3) PST/Tel/HC.
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