Service or Program: The Backus Hospital Medication Management Clinic located in Norwich, CT provides a newly implemented Direct Oral Anticoagulant (DOAC) management service. This service is provided by a clinical pharmacist for patients with non-valvular atrial fibrillation or venous thromboembolism. The clinical pharmacist assists in the initiation, monitors for the efficacy and safety, and provides education on the benefits and risks of DOAC therapy. The clinical pharmacist communicates to the referring physicians on any significant concerns or recommendations with DOAC therapy. Lifestyle, renal function, and other medication use will be evaluated to ensure safety and stability. The referred patients will be discharged from the clinic when they have been on DOAC for an extended duration (typically >6 months). Prior to discharge, the patients will be assessed to ensure that they are well-educated on signs and symptoms of adverse events to DOAC agents and what actions to take if these events were to arise.
Justification/Documentation: Many providers choose a DOAC for anticoagulation because of the ease of administration and fewer drug and food interactions compared to warfarin. However, they forego any follow-up with patients on DOAC agents believing it is unwarranted. On the contrary, a growing body of evidence and expert opinion supports the importance of follow-up monitoring for these patients. Pharmacists can intervene and improve the patients’ adherence, monitor for adverse events, and potentially improve their outcomes.
Adaptability: This DOAC management service can be implemented in pharmacist-driven anticoagulation clinics. Many anticoagulation clinics are already staffed with healthcare professionals, who are well trained at evaluating and educating patients for the signs and symptoms of thrombosis and bleeding. The same concept along with renal function monitoring is applied in this DOAC management program.
Significance: The role of a clinical pharmacist is expanding rapidly in the healthcare world. Pharmacist are now viewed as a valuable member of a healthcare team. This new DOAC management program is following this trend of expanding the pharmacist’s role. With the increased use of DOAC agents, pharmacist’s expanded service will redefine anticoagulation care.
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