Bringing the Benefits of Anticoagulation Management Services to the Community

Abstract

Background: While warfarin is efficacious for the prevention of thromboembolic disorders, many patients are undertreated. To optimize therapy, anticoagulation management services (AMSs) deliver a coordinated, focused approach to this care; however, AMSs are limited in their ability to impact patients outside of tertiary care settings. Objective: To describe the methods used to develop community-based AMSs across Alberta. Methods: Through a three-staged approach, this project created community-based, pharmacist-managed AMSs for patients requiring warfarin therapy. Stage I was the initiation of a central or “core” AMS, located at a quaternary referral centre. Starting with the core enabled us to develop and test the program and create an environment to serve as a training and support centre for future aspects of the program. Next, an educational program was developed and implemented (Stage II) for a diverse group of pharmacists to establish and manage a community-based or “satellite” AMS (Stage III) at their practice site. All three stages are undergoing detailed evaluation, capturing project-specific (patient outcome) data as well as system-level (integration within the health care infrastructure) data. Conclusion: By offering a focused, coordinated, and consistent approach to warfarin management, with ongoing collaboration with other providers, the ultimate goal of this program is to optimize patient outcomes. Utilizing pharmacists as central players within a collaborative setting will enhance the use of our current infrastructure. This program may serve as a model for other health regions and other chronic diseases.