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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

Citation

Stafford, L and Peterson, GM and Bereznicki, LRE and Jackson, SL, 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 Services Research, 11, (16) pp. 1-11. ISSN 1472-6963 (2011) [Contribution to Refereed Journal]


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Copyright Statement

Copyright ©2011 Stafford et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Official URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC304070...

DOI: doi:10.1186/1472-6963-11-16

Abstract

Background: Shorter periods of hospitalisation and increasing warfarin use have placed stress on communitybased healthcare services to care for patients taking warfarin after hospital discharge, a high-risk period for these patients. A previous randomised controlled trial demonstrated that a post-discharge service of 4 home visits and point-of-care (POC) International Normalised Ratio (INR) testing by a trained pharmacist improved patients’ outcomes. The current study aims to modify this previously trialled service model to implement and then evaluate a sustainable program to enable the smooth transition of patients taking warfarin from the hospital to community setting. Methods/Design: The service will be trialled in 8 sites across 3 Australian states using a prospective, controlled cohort study design. Patients discharged from hospital taking warfarin will receive 2 or 3 home visits by a trained ‘home medicines review (HMR)-accredited’ pharmacist in their 8 to 10 days after hospital discharge. Visits will involve a HMR, comprehensive warfarin education, and POC INR monitoring in collaboration with patients’ general practitioners (GPs) and community pharmacists. Patient outcomes will be compared to those in a control, or ‘usual care’, group. The primary outcome measure will be the proportion of patients experiencing a major bleeding event in the 90 days after discharge. Secondary outcome measures will include combined major bleeding and thromboembolic events, death, cessation of warfarin therapy, INR control at 8 days post-discharge and unplanned hospital readmissions from any cause. Stakeholder satisfaction will be assessed using structured postal questionnaire mailed to patients, GPs, community pharmacists and accredited pharmacists at the completion of their study involvement. Discussion: This study design incorporates several aspects of prior interventions that have been demonstrated to improve warfarin management, including POC INR testing, warfarin education and home visits by trained pharmacists. It faces several potential challenges, including the tight timeframe for patient follow-up in the postdischarge period. Its strengths lie in a strong multidisciplinary team and the utilisation of existing healthcare frameworks. It is hoped that this study will provide the evidence to support the national roll-out of the program as a new Australian professional community pharmacy service.

Item Details

Item Type:Contribution to Refereed Journal
Research Division:Medical and Health Sciences
Research Group:Pharmacology and Pharmaceutical Sciences
Research Field:Clinical Pharmacy and Pharmacy Practice
Objective Division:Health
Objective Group:Health and Support Services
Objective Field:Health and Support Services not elsewhere classified
UTAS Author:Stafford, L (Dr Leanne Chalmers)
UTAS Author:Peterson, GM (Professor Gregory Peterson)
UTAS Author:Bereznicki, LRE (Professor Luke Bereznicki)
UTAS Author:Jackson, SL (Dr Shane Jackson)
ID Code:66474
Year Published:2011
Web of Science® Times Cited:6
Deposited By:Pharmacy
Deposited On:2011-01-27
Last Modified:2012-10-02
Downloads:386 View Download Statistics

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