Abstract
Objective To describe the development, implementation and outcomes of an anticoagulation education program for pharmacists participating in a community-based post-discharge warfarin management service. Setting Australian community pharmacy practice. Method Three education modules were developed in collaboration with medical experts and delivered electronically and via hands-on training sessions to pharmacists in three Australian states. Educational outcomes were assessed via a short answer assignment and evaluation of their warfarin dosing recommendations for five hypothetical scenarios. Consumer and pharmacist perceptions of the adequacy of the training were surveyed using a structured postal questionnaire. Main outcome measure Pharmacists’ score in the short answer assignment and evaluation of their responses to the hypothetical warfarin dosing scenarios. Results Sixty-two pharmacists successfully completed the training program with a mean score for the short answer assignment of 14.3 out of 15 (95.3%; 95% CI 13.8–14.7). The pharmacists’ warfarin management recommendations were very similar to those of two experienced medical specialists. Pharmacists and consumers expressed confidence in the adequacy of the training program. Conclusion This education program successfully up-skilled a cohort of pharmacists for involvement in a post-discharge warfarin management service. These findings support formalisation and further development of the program to facilitate widespread implementation of home-based post-discharge warfarin care.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(Suppl 6):160S–98S.
Department of Health and Ageing. Medicare Australia statistics; 2008. Cited 2008 Oct 9. https://www.medicareaustralia.gov.au/statistics/pbs_item.shtml.
Burgess CL, Holman CD, Satti AG. Adverse drug reactions in older Australians, 1981–2002. Med J Aust. 2005;182:267–70.
Hirri HM, Green PJ. Audit of anticoagulant therapy and acute hospital admissions. Clin Lab Haem. 2002;24:43–5.
Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18820 patients. Br Med J. 2004;329:15–9.
Fihn SD, McDonell M, Martin D, Henikoff J, Vermes D, Kent D, et al. Risk-factors for complications of chronic anticoagulation—a multicenter study. Warfarin optimized outpatient follow-up study group. Ann Intern Med. 1993;118:511–20.
Landefeld CS, Goldman L. Major bleeding in outpatients treated with warfarin—incidence and prediction by factors known at the start of outpatient therapy. Am J Med. 1989;87:144–52.
Levine MN, Raskob G, Landefeld S, Kearon C. Hemorrhagic complications of anticoagulant treatment. Chest. 2001;119(Suppl 1):108S–21S.
Campbell P, Roberts G, Eaton V, Coghlan D, Gallus A. Managing warfarin therapy in the community. Aust Prescr. 2001;24:86–9.
Jackson S, Peterson G, Vial J, Jupe D. Suboptimal anticoagulant management in patients after hospital initiation of warfarin. Aust Fam Physician. 2004;33:477–8.
Ingelgard A, Hollowell J, Reddy P, Gold K, Tran K, Fitzmaurice D. What are the barriers to warfarin use in atrial fibrillation?: Development of a questionnaire. J Thromb Thrombolysis. 2006;21:257–65.
Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–7.
Jackson SL, Peterson GM, Vial JH, Jupe DM. Improving the outcomes of anticoagulation: an evaluation of home follow-up of warfarin initiation. J Intern Med. 2004;256:137–44.
Medicare Australia. Home Medicines Review (HMR); 2010. cited 2010 Apr 23. http://www.medicareaustralia.gov.au/provider/pbs/fourth-agreement/hmr.jsp.
Lalonde L, Martineau J, Blais N, Montigny M, Ginsberg J, Fournier M, et al. Is long-term pharmacist-managed anticoagulation service efficient? A pragmatic randomized controlled trial. Am Heart J. 2008;156:148–54.
Witt D. The Kaiser Permanente Colorado Clinical Pharmacy Anticoagulation Service as a model of modern anticoagulant care. Thromb Res. 2008;123(Suppl 1):S36–41.
Rudd K, Dier J. Comparison of two different models of anticoagulation management services with usual medical care. Pharmacotherapy. 2010;30:330–8.
Coudret N, Oertel L. Workshop: internet delivery of an anticoagulation therapy management certificate program. J Thromb Thrombolysis. 2000;9:S57–9.
Acknowledgments
The authors would like to acknowledge: Professor David Fitzmaurice and Dr Ellen Murray from the University of Birmingham for their assistance in the formulation of the initial training program; Roche Diagnostics Australia, the National Institute of Clinical Studies (NICS), and the AACP for their support; and Dr David Jupe, Dr Ellen Maxwell and Associate Professor Janet Vial for their assistance in the preparation of the dosage adjustment scenarios. This project was funded by the Australian Government Department of Health and Ageing as part of the Fourth Community Pharmacy Agreement through the Fourth Community Pharmacy Agreement Grants Program managed by the Pharmacy Guild of Australia. The authors would also like to acknowledge the National Safety and Quality Council for providing the funding for the initial development of the training program.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stafford, L., Peterson, G.M., Bereznicki, L.R. et al. Training Australian pharmacists for participation in a collaborative, home-based post-discharge warfarin management service. Pharm World Sci 32, 637–642 (2010). https://doi.org/10.1007/s11096-010-9416-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-010-9416-7