Purpose. A methodological approach was developed to facilitate expansion of clinical pharmacist-managed anticoagulation services across an integrated health care delivery network.
Methods. A stepwise approach to the development and implementation of ambulatory care clinical pharmacy services was used to facilitate expansion of pharmacistmanaged anticoagulation clinics in a university hospital setting and a community hospital within the same health network.
Results. The Health Alliance of Greater Cincinnati successfully created a care delivery model using clinical pharmacists to provide comprehensive anticoagulation management services at a university hospital and a community hospital. The incidence of thromboembolic events was significantly lower in the pharmacy anticoagulation service patients versus the patients in the usual care setting (p = 0.005). A statistically significant decrease in minor bleeding events was observed in the pharmacist-managed group (p = 0.038). Although a decrease in major bleeding events was observed, it was not statistically significant (p = 0.075). International Normalized Ratio values of the patients managed by the pharmacy anticoagulation clinics were within the therapeutic range approximately 75% of the time.
Conclusion. A stepwise approach to the development and implementation of ambulatory care clinical pharmacy services has facilitated the expansion of pharmacistmanaged anticoagulation clinics across an integrated health system. This may serve as a valuable template for other systems as they strive to develop medication therapy management services.
Copyright © 2007. American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/04/0602-1242$06.00
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Kelly Epplen, Michelle Dusing-Wiest, Joanna Freedlund, Nicole Harger, Susan Kathman, Marianne F. Ivey
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