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


Stafford, L and Peterson, GM and Bereznicki, LRE and Jackson, SL and Van Tienen, EC and Angley, MT and Bajorek, BV and McLachlan, AJ and Mullan, JR and Misan, GMH and Gaetani, L, Clinical Outcomes of a Collaborative, Home-Based Postdischarge Warfarin Management Service, The Annals of Pharmacotherapy, 45, (3) pp. 325-334. ISSN 1060-0280 (2011) [Refereed Article]

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Copyright © 2011 by Harvey Whitney Books Company.

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DOI: doi:10.1345/aph.1P617


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.

Item Details

Item Type:Refereed Article
Keywords:adverse drug events, community pharmacy services, international
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacy and pharmacy practice
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
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)
UTAS Author:Van Tienen, EC (Mrs Ella van Tienen)
ID Code:68859
Year Published:2011
Web of Science® Times Cited:28
Deposited By:Pharmacy
Deposited On:2011-03-28
Last Modified:2017-11-02
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