Anticoagulation control of pharmacist-managed collaborative care versus usual care in Thailand

Saokaew, Surasak, Sapoo, Ubonwan, Nathisuwan, Surakit, Chaiyakunapruk, Nathorn and Permsuwan, Unchalee (2012) Anticoagulation control of pharmacist-managed collaborative care versus usual care in Thailand. International Journal of Clinical Pharmacy, 34 1: 105-112.

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Author Saokaew, Surasak
Sapoo, Ubonwan
Nathisuwan, Surakit
Chaiyakunapruk, Nathorn
Permsuwan, Unchalee
Title Anticoagulation control of pharmacist-managed collaborative care versus usual care in Thailand
Journal name International Journal of Clinical Pharmacy   Check publisher's open access policy
Publication date 2012-02
Sub-type Article
Year available 2011
DOI 10.1007/s11096-011-9597-8
Volume number 34
Issue number 1
ISSN 2210-7703
2210-7711
Start page 105
End page 112
Total pages 8
Place of publication Dordrecht, Netherlands
Publisher Springer
Collection year 2012
Language eng
Formatted abstract Objective There has been a lack of evidence of the effects of pharmacist-managed warfarin therapy (PMWT) in developing countries (e.g. Southeast Asian countries) where the patients’ characteristics, genetic make-up, clinical practice and healthcare system are different from the Western world. This study aimed to compare the anticoagulation control and clinical outcomes associated with warfarin therapy provided by PMWT to usual care (UC) in the Thai population. Setting A 1,000-bed tertiary-care hospital in Nakornratchasima province of Thailand. Method A quasi-experimental study comparing PMWT and UC in patients receiving long-term warfarin therapy. For PMWT group, clinical pharmacists optimised the warfarin therapy and suggested recommendations (e.g. dose adjustment, safer alternative drugs, and follow-up time) to physicians. The UC group received the standard care. Main outcome measure Time in therapeutic range (TTR), both actual- and expanded-TTR, bleeding and thromboembolic complications, and physician’ acceptance of pharmacist suggestions. Results Of 433 patients enrolled, 220 and 213 were in the PMWT and UC groups respectively. At baseline, patient’s characteristics of both groups were comparable. At the end of follow-up period, patients in the PMWT group had significantly higher actual-TTR (48.3% vs. 40.1%; P < 0.001) and expanded-TTR (62.7% vs. 53.9%; P < 0.001) compared to those in the UC group. Rates of major bleeding were 4.4 vs 4.5 events per 100 person-years for the PMWT and UC groups, respectively. Pharmacists performed 284 interventions with an acceptance rate of 80.3% from physicians. Conclusion Pharmacist-managed warfarin therapy resulted in a significantly better anticoagulation control. This study showed that a collaborative approach in anticoagulation management can be successfully implemented in a developing country. Implementation of such care model in other developing countries should be considered.
Keyword Anticoagulation control
Anticoagulation management service
Bleeding
Clinical outcome
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online: 28 December 2011

Document type: Journal Article
Sub-type: Article
Collections: Official 2013 Collection
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