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Clinical Outcomes of a Collaborative, Home-Based Postdischarge Warfarin Management Service

journal contribution
posted on 2023-05-17, 05:33 authored by Leanne ChalmersLeanne Chalmers, Gregory PetersonGregory Peterson, Luke BereznickiLuke Bereznicki, Shane JacksonShane Jackson, Ella van TienenElla van Tienen, Angley, MT, Bajorek, BV, McLachlan, AJ, Mullan, JR, Misan, GMH, Gaetani, L
BACKGROUND: Warfarin remains a high-risk drug for adverse events, especially following discharge from the hospital. New approaches are needed to minimize the potential for adverse outcomes during this period. OBJECTIVE: To evaluate the clinical outcomes of a collaborative, home-based postdischarge warfarin management service adapted from the Australian Home Medicines Review (HMR) program. METHODS: In a prospective, nonrandomized controlled cohort study, patients discharged from the hospital and newly initiated on or continuing warfarin therapy received either usual care (UC) or a postdischarge service (PDS) of 2 or 3 home visits by a trained, HMR-accredited pharmacist in their first 8 to 10 days postdischarge. The PDS involved point-of-care international normalized ratio (INR) monitoring, warfarin education, and an HMR, in collaboration with the patient’s general practitioner and community pharmacist. The primary outcome measure was the combined incidence of major and minor hemorrhagic events in the 90 days postdischarge. Secondary outcome measures included the incidences of thrombotic events, combined hemorrhagic and thombotic events, unplanned and warfarin-related hospital readmissions, death, INR control, and persistence with therapy at 8 and 90 days postdischarge. RESULTS: The PDS (n = 129) was associated with statistically significantly decreased rates of combined major and minor hemorrhagic events to day 90 (5.3% vs 14.7%; p = 0.03) and day 8 (0.9% vs 7.2%; p = 0.01) compared with UC (n = 139). The rate of combined hemorrhagic and thrombotic events to day 90 also decreased (6.4% vs 19.0%; p = 0.008) and persistence with warfarin therapy improved (95.4% vs 83.6%; p = 0.004). No significant differences in readmission and death rates or INR control were demonstrated. CONCLUSIONS: This study demonstrated the ability of appropriately trained accredited pharmacists working within the Australian HMR framework to reduce adverse events and improve persistence in patients taking warfarin following hospital discharge. Widespread implementation of such a service has the potential to enhance medication safety along the continuum of care.

Funding

Department of Health and Aged Care

History

Publication title

The Annals of Pharmacotherapy

Volume

45

Pagination

325-334

ISSN

1060-0280

Department/School

School of Pharmacy and Pharmacology

Publisher

Harvey Whitney Books Co

Place of publication

Po Box 42696, Cincinnati, USA, Oh, 45242

Rights statement

Copyright © 2011 by Harvey Whitney Books Company.

Repository Status

  • Restricted

Socio-economic Objectives

Evaluation of health outcomes

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    University Of Tasmania

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