THE EFFECTS OF PHARMACIST’S COUNSELING ON WARFARIN-RELATED CLINICAL OUTCOMES IN PHARMACY’S AMBULATORY CARE
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Abstract
The objective of this study was to determine the effects of the pharmacist counseling on warfarin management to outpatients who visited McCormick hospital, Chiang Mai, Thailand. Comparison of pre- and post-counseling service conducted over a period of 5 months. The outcomes were international normalized ratio (INR) control (therapeutic efficacy), warfarin-related complications and adverse events (safety), patients’ knowledge and satisfaction regarding warfarin. The data were collected from 26 outpatients who were prescribed warfarin. There were 16 patients (64.0%) who received pre-counseling service had out-of-range INR. There were 14 patients (87.5%) had sub-therapeutic INR. The analysis of INR control within the therapeutic range was not statistically different between pre- and post-counseling services (p=0.062). Thromboembolic complications were found in 4 patients (15.4%) and bleeding complications were found in 3 patients (11.5%) during pre-counseling period. Interestingly, thromboembolic and bleeding complications were not detected after post-counseling services (0%). Before receiving counseling service, the most 3 incorrect answers on warfarin knowledge were the effect of a missing dose and its management, the benefit of INR monitoring and the possible adverse effects of sub-therapeutic INR. Patient’s knowledge on warfarin among participants significantly increased after receiving counseling services (p<0.001). In addition, all participated outpatients satisfied with pharmacist counseling services. Taken together, this study demonstrated that pharmacist’s counseling could improve warfarin-associated complications, warfarin knowledge and patient’s satisfaction in pharmacy’s ambulatory care.
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References
Abdel-Aziz MI, Ali MA, Hassan AK, Elfaham TH. 2015. Factors influencing warfarin response in hospitalized patients. Saudi Pharm. J. 23:642-9.
Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. 2008. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:160s-98s.
Baker JW, Pierce KL, Ryals CA. 2011. INR goal attainment and oral anticoagulation knowledge of patients enrolled in an anticoagulation clinic in a Veterans Affairs medical center. J. Manag. Care Pharm. 17:133-42.
Chilipko AA, Norwood DK. 2014. Evaluating warfarin management by pharmacists in a community teaching hospital. Consult. Pharm. 29:95-103.
Collins S, Barber A, Sahm L. 2014. Pharmacist’s counseling improves patient knowledge regarding warfarin, irrespective of health literacy level. Pharmacy 2:114.
Krittathanmakul S, Silapachote P, Pongwecharak J, Wongsatit U. 2006. Effects of pharmacist counseling on outpatients receiving warfarin at Songklanagarind Hospital. Songkla. Med. J. 24(2):93-9.
Kuruvilla M, Gurk-Turner C. 2001. A review of warfarin dosing and monitoring. Proc (Bayl Univ. Med. Cent.) 14:305-6.
Lakshmi R, James E, Kirthivasan R. 2013. Study on impact of clinical pharmacist's interventions in the optimal use of oral anticoagulants in stroke patients. Indian J. Pharm. Sci. 75:53-9.
Locke C, Ravnan SL, Patel R, Uchizono JA. 2005. Reduction in warfarin adverse events requiring patient hospitalization after implementation of a pharmacist-managed anticoagulation service. Pharmacotherapy 25:685-9.
Poon IO, Lal L, Brown EN, Braun UK. 2007. The impact of pharmacist-managed oral anticoagulation therapy in older veterans. J. Clin. Pharm. Ther. 32:21-9.
Rudd KM, Dier JG. 2010. Comparison of two different models of anticoagulation management services with usual medical care. Pharmacotherapy 30:330-8.
Shrestha S, Sapkota B, Kumpakha A, Acharya U, Sharma R. 2015. Evaluation of patients' knowledge on warfarin in outpatient pharmacy of a tertiary care cardiac center. BMC Res. Notes 8:429.
Shuaib W, Iftikhar H, Alweis R, Shahid H. 2014. Warfarin therapy: Survey of patients' knowledge of their drug regimen. Malays. J. Med. Sci. 21:37-41.
Stafford L, Peterson GM, Bereznicki LR, Jackson SL. 2011. A role for pharmacists in community-based post- discharge warfarin management: protocol for the 'the role of community pharmacy in post hospital management of patients initiated on warfarin' study. BMC Health Serv. Res. 11:16.
Tang EO, Lai CS, Lee KK, Wong RS, Cheng G, Chan TY. 2003. Relationship between patients' warfarin knowledge and anticoagulation control. Ann. Pharmacother. 37:34-9.
Waterman AD, Banet G, Milligan PE, Frazier A, Verzino E, Walton B, et al. 2001. Patient and physician satisfaction with a telephone-based anticoagulation service. J. Gen. Intern. Med. 16:460-3.