Authors (including presenting author) :
Carol S Y FAN1, Ophelia H M TAM1, Trevor C F MAK1, Nicole M Y TAM1, Angela H K LIU1, Dr K K CHAN2
Affiliation :
1 Department of Pharmacy, Pamela Youde Nethersole Eastern Hospital
2 Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
Pharmacist Anticoagulation Clinic (PAC) has been implemented in PYNEH as a regular SOPC service since 8/2020. Medical doctors could refer patients who were prescribed Warfarin for clinical monitoring between the medical doctors’ SOPC appointments.
Objectives :
1. To review the Time in Therapeutic Range (TTR) before and after PAC implemented
2. To assess the impact of PAC on the clinical monitoring
Methodology :
This was a retrospective review of patients prescribed Warfarin at PYNEH. Patients who were prescribed Warfarin in 3/2023 were included in the Group A. Group A patients who were also prescribed Warfarin since 4/2019 were included in the Group B. INR performed Apr 2022 - April 2023 and July 2019 - June 2020 for Groups A and B were collected, respectively. All patients who were admitted during the two study periods were excluded. TTR would be calculated for patients with ≥2 INR measured within the study period
Result & Outcome :
One hundred and fifty patients and eighty-five patients were included in Groups A and B, respectively.
In Group A, two patients had < 2 INR measured within the study period. One hundred and forty-eight patients were included in the TTR and INR monitoring review (patients with ≥1 PAC attendance: 123; patients without PAC attendance: 25). The average TTR was 69.3% (with PAC: 68.9%; without PAC: 71.6%), 57% of patients with TTR≥70% (with PAC: 56%; without PAC: 58%). The average INR monitoring interval was 7.3 weeks (with PAC 6.7 weeks; without PAC 13.7 weeks), with 110 patients (74%) had ≥1 INR intervals >12 weeks (with PAC: 87 [70.3%]; without PAC: 23 [92%]).
In Group B, seven patients had < 2 INR measured within the study period. Seventy-eight patients were included in the TTR and INR monitoring review. The average TTR was 69.4%, 56% of patients with TTR≥70%. The average INR monitoring interval was 11 weeks, with 72 patients (92.3%) having ≥1 INR interval>12 weeks.
Conclusion
TTR was similar before and after the implementation of the PAC. Patients who were ever referred to PAC were more likely to have an INR monitoring interval ≤12 weeks. The clinical effectiveness and safety of patients monitored under the interdisciplinary medical doctor-pharmacist consultation clinic model are maintained.
