Pharmacist-managed Warfarin in Pediatric Cardiac Patients: Quality-improvement Study
| Autor: | Elizabeth Woods, Carrie Tilton, Derek A. Williams, Mary Subramanian, Lauren Wyatt |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Health (social science) Quality management business.industry health care facilities manpower and services Health Policy education Public Health Environmental and Occupational Health Pharmacist Warfarin Medicine (miscellaneous) Health Professions (miscellaneous) Washout period Therapeutic index health services administration Internal medicine Usual care medicine cardiovascular diseases business health care economics and organizations Pediatric cardiology Pediatric population medicine.drug |
| Zdroj: | Universal Journal of Public Health. 6:102-107 |
| ISSN: | 2331-8945 2331-8880 |
| DOI: | 10.13189/ujph.2018.060210 |
| Popis: | Objective: To compare the efficacy of warfarin management by a pharmacist-managed group to a cardiologist-managed group (usual care) in an outpatient pediatric population. Methods: Fourteen patients with an international normalized ratio (INR) goal determined by a cardiologist were included. The pharmacist-managed group included twelve patients. There were seven patients in the cardiologist-managed group. Prior to the transition to a pharmacist-managed service in September 2014, cardiologists managed anticoagulation. For the cardiologist-managed group, INR values were recorded for six months. Following a washout period of three months, INR values were obtained for the pharmacist-managed group for the subsequent six months. Patients were included in each analysis if they were followed for more than 3 months. A protocol guided dose adjustments, recommended monitoring, and allowed for pharmacist-managed warfarin. Results: The median number of INR tests per patient was not significantly lower in the cardiologist-managed group compared to the pharmacist-managed group (28 versus 36 measurements, p=0.06). The median percentage of time in therapeutic range using the Rosendaal method was not significantly higher in the pharmacist-managed group compared to the cardiologist-managed group (55.5% versus 54%, p=0.93). The median percentage of values in therapeutic range using the traditional method was also not significantly higher in the pharmacist-managed group compared to the cardiologist-managed group (41.9% versus 36.8%, p=0.93). Conclusion: Warfarin management in a pharmacist-managed group compared to a cardiologist-managed group provided similar care. Differences in time in therapeutic range and median values in therapeutic range were not found between the pharmacist-managed group and cardiologist-managed group. These results describe and provide support that pharmacist-managed anticoagulation of pediatric cardiology patients is safe and effective in the outpatient setting. |
| Databáze: | OpenAIRE |
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