Community pharmacy anticoagulation service can achieve high clinical outcomes, evaluation shows

A research evaluation has been published on the Community Pharmacy Anticoagulation Management service in the journal BMC Health Services Research. This evaluation has shown that community pharmacy is ideally positioned to support the commissioning of key services from primary care providing good clinical outcomes whilst attaining high patient satisfaction for the level of service and skills of the pharmacy team involved.

The service was commissioned to transfer and maintain existing non-complex patients prescribed warfarin in secondary care within Brighton and Hove to clinics run on the pharmacy premises or via a domiciliary service.

The service was commissioned to address some of the challenges faced by patients who require anticoagulant monitoring in secondary care – namely the accessibility of a centralised clinic supporting a wide geographical area – by bringing the service closer to the patient.

What did the service involve?

Patients were eligible for referral if they had at least two out of their last four readings in target range and did not fall into the exclusion criteria. Patients referred on to the service were non-complex and included either those requiring warfarin initiation or those who had already completed the initiation period and required ongoing monitoring.

At each clinic appointment a patient’s INR was measured by taking a capillary blood sample using a finger prick device and analysed using the same device. The INR result was input into software which provided pharmacists with support on dosing and recall interval decisions. The system also provided an appointment book which could track patients and ensure follow up appointments are audited and actioned, as well as providing the pharmacists with detailed patient anticoagulation history and warfarin dosing algorithms.

Level of patient satisfaction with the service was measured by undertaking an annual patient survey.

What did the evaluation show?

This evaluation supports previous studies which have shown that community pharmacy-based anticoagulation clinics can be safe and clinically effective. Patients’ overall satisfaction for the service over the three years of data was very high, with feedback consistently rating above 98% at a minimum of ‘good’ whilst showing 67% rating the service as excellent. The evaluation has demonstrated that a community pharmacy managed anticoagulation service can achieve clinical outcomes at a level consistently exceeding targets.

Details on other community pharmacy anticoagulant services can be found on the Community Pharmacy England Services Database.