Impact of a pharmacist-led education and follow-up service on anticoagulation control and safety outcomes at a tertiary hospital in China: a randomised controlled trial

Author:

Liang Jia-Bi1,Lao Cheng-Kin2ORCID,Tian Lin1,Yang Ying-Ying1,Wu Hui-Min1,Tong Henry Hoi-Yee2,Chan Alexandre3

Affiliation:

1. Department of Pharmacy, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China

2. School of Health Sciences and Sports, Macao Polytechnic Institute, Macao S.A.R., China

3. Department of Pharmacy, National University of Singapore, Singapore, Singapore

Abstract

Abstract Objectives This study was designed to evaluate the impact of a pharmacist-led anticoagulation service on international normalised ratio (INR) control and other outcomes among patients receiving warfarin therapy at a tertiary hospital in Zhuhai, China. Methods In this randomised controlled trial, adult patients who were newly initiated on warfarin with intended treatment duration of at least 3 months were recruited. Participants were randomly allocated to receive the pharmacist-led education and follow-up service (PEFS) or usual care (UC). Anticoagulation control was calculated as the proportions of time within the target INR range (TTR) and time within the expanded target range (TER). Key findings A total of 152 participants (77 in the PEFS group and 75 in the UC group) were included. Within 180 days after hospital discharge, the PEFS group spent more TER than the UC group (54.4% versus 42.0%; P = 0.024), whereas the difference in TTR did not reach statistical significance (35.9% versus 29.5%; P = 0.203). No major bleeding events were observed, and the cumulative incidences of major thromboembolic events (6.5% versus 9.3%) and mortality (1.3% versus 1.3%) were similar between the two groups (P> 0.05). At 30 days postdischarge, the PEFS group had better warfarin knowledge by answering 57.5% of questions correctly, compared with the UC group (43.0%) (P = 0.003). Conclusions The PEFS markedly enhanced anticoagulation control and warfarin knowledge but there was room for improvement. The expansion of pharmacists’ clinical role and the development of more effective education and follow-up strategies are warranted to optimise anticoagulation management services in China.

Funder

Macao Polytechnic institute

Publisher

Oxford University Press (OUP)

Subject

Public Health, Environmental and Occupational Health,Health Policy,Pharmaceutical Science,Pharmacy

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