Trends in anticoagulation management services following incorporation of direct oral anticoagulants at a large academic
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Trends in anticoagulation management services following incorporation of direct oral anticoagulants at a large academic medical center Caitlin Mills1 · Melissa J. Snider1 · Tiffany C. Ortman1 · Aaron Dush1 · Margueritte S. Hevezi1 · Junan Li1 · Raul Weiss1 · Eric Kraut1 Accepted: 17 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The introduction of direct oral anticoagulants (DOACs) to the market has expanded anticoagulation options for outpatient use. Routine evaluation by health care professionals is recommended as it is with warfarin, therefore requiring adjustments in practices of anticoagulation management services (AMS). This study aims to describe trends that occurred following the incorporation of DOACs into AMS at a large academic medical center. A retrospective chart review of pharmacist-run AMS was used to compare patients on DOAC therapy versus other types of anticoagulation, including warfarin and parenteral agents. Primary outcomes included trends in the number of unique patients, management encounters, and telephone encounters throughout the study period. Secondary outcomes included trends in new encounters, and changes in patient characteristics, resources utilized, and patient satisfaction scores. A total of 2976 unique patients, 74,582 management encounters, and 13,282 telephone encounters were identified. From study beginning to end, results showed stable numbers of unique patients, an increase in management encounters for the DOAC group and decrease in the other anticoagulants group, and stable numbers of telephone encounters. Additionally, the number of new encounters for both groups increased. Throughout the study, pharmacy resources were reallocated within anticoagulation to adapt to the changing trends and patient satisfaction reached targets. Patients’ characteristics remained stable, with the DOAC group having fewer comorbid conditions and concomitant medications that could increase bleed risk. This study showed that by reallocating resources within anticoagulation, AMS can maintain stable patient populations while continuing to expand access and satisfy patients following DOAC inclusion. Keywords Anticoagulation management service · Clinical pharmacy · DOAC
Highlights • The number of unique patients seen over the four-year
study period remained stable following increased incorporation of DOACs to the AMS model • An increase in new patient encounters occurred for both the DOAC group and the other anticoagulants group • Through resource allocation, the number of clinics and types of medications monitored increased despite the decreased frequency of encounters for DOAC therapy * Melissa J. Snider [email protected] 1
The Ohio State University Wexner Medical Center, Columbus, OH 43228, USA
• Future studies should be published to include data on
clinical outcomes related to pharmacist-run AMS in the era of DOAC inclusion
Background The use of oral anticoagulants has largely been recognized as an effective means for a variety of
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