Pharmacist Monitoring of Direct Oral Anticoagulants for American Indians and Alaska Natives in the Outpatient Setting

Blister Packaging Medications for Adherence for American Indians/Alaska Natives in the Outpatient Setting

Journal of Pharmacy Practice ◽

10.1177/0897190019851357 ◽

2019 ◽

pp. 089719001985135

Author(s):

LT Sean Navin

Keyword(s):

Cognitive Impairment ◽

American Indians ◽

Alaska Native ◽

Medication Possession Ratio ◽

Patient Characteristics ◽

Outpatient Setting ◽

Alaska Natives ◽

Blister Pack ◽

Before And After ◽

One Year

Objective: To compare adherence one year before and after blister pack implementation in America Indian and Alaska Native (AI/AN) patients and to describe the patient population who used blister packs in the outpatient setting. Methods: A retrospective analysis of AI/AN patients receiving blister packs was performed to determine medication adherence as measured by a variable medication possession ratio (MPR). Patient characteristics and the reason for blister pack initiation were also assessed. Results: Of the 25 patients receiving blister packs, 76% were female, 56% were elderly and 60% had cognitive impairment. The three most common types of medications used were hypertension meds, vitamins and diabetes meds. The average MPR one year before blister pack implementation was 67.4% and significantly increased to 86.0% one year after. Conclusion: Blister packs significantly increased the average MPR after one year of implementation in a small group of AI/AN patients. Blister packs were utilized most commonly in patients who were female, had cognitive impairment, and who were taking numerous medications with a high pill burden in the outpatient setting.

Download Full-text

Evaluation of Direct Oral Anticoagulant Dosing and Monitoring in Two Geriatric Outpatient Clinics

The Senior Care Pharmacist ◽

10.4140/tcp.n.2019.192 ◽

2019 ◽

Vol 34 (3) ◽

pp. 192-205

Author(s):

Michelle A. Howerton ◽

Erin M. Suhrie ◽

Amelia S. Gennari ◽

Nancy Jones ◽

Christine M. Ruby

Keyword(s):

Medical Center ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Retrospective Chart Review ◽

Office Visit ◽

Outpatient Setting ◽

Primary Objective ◽

Improvement Project ◽

Care Institute ◽

Geriatric Center

OBJECTIVE: This study was conducted to evaluate direct oral anticoagulants (DOACs) prescribed to elderly patients in an outpatient setting, specifically evaluating if Food and Drug Administration (FDA) -approved dosing recommendations are followed. DESIGN: This study was a retrospective quality improvement project. SETTING: This study was conducted at geriatric hospital-based primary care clinics at the University of Pittsburgh Medical Center (UPMC), UPMC Senior Care Institute and UPMC Benedum Geriatric Center. PATIENTS: Subjects included were 65 years of age or older; had an office visit at UPMC Senior Care Institute or UPMC Benedum Geriatric Center from September 1, 2015, to August 31, 2017; and had a DOAC on their home medications. INTERVENTIONS: Data were obtained through retrospective chart review. MAIN OUTCOME MEASURE: The primary objective of the study was to evaluate the appropriateness of dosing of DOACs based on FDA-labeled recommendations. RESULTS: Of 232 patients included in analysis, 42.7% were found to have dosing inconsistent with FDAlabeled recommendations (47.3% apixaban, 35.8% rivaroxaban, and 31.6% dabigatran). No patients were prescribed edoxaban. The majority (72.7%) were dosed lower than FDA-recommended doses. Of all patients, the most frequent parameter (54.5%) for inappropriate dosing was patients meeting only 1 of 3 dose-reduction criteria when prescribed reduced-dose apixaban. Geriatrician and nongeriatrician prescribers had similar rates of prescribing DOACs with doses inconsistent with FDA-labeled recommendations (44.0% vs. 40.8%; P = 0.62). CONCLUSION: Results suggest that DOACs used in outpatient geriatric patients are frequently dosed inconsistent with FDA-approved dosing recommendations. Further research is needed regarding clinical outcomes in older patients receiving DOACs and in those with dose adjustments inconsistent with FDA-labeled recommendations.

Download Full-text

Impact of a Pharmacist Intervention in the Emergency Department on the Appropriateness of Direct Oral Anticoagulants Prescribed in Venous Thromboembolism Patients

Journal of Pharmacy Practice ◽

10.1177/08971900211000704 ◽

2021 ◽

pp. 089719002110007

Author(s):

Kristen H. Bakey ◽

Cam-Tu N. Nguyen

Keyword(s):

Venous Thromboembolism ◽

Medication Errors ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Pharmacist Intervention ◽

Outpatient Setting ◽

Low Risk ◽

Clinical Pharmacy Service ◽

Discharge Medication ◽

Reduced Rate

Background: It is now widely accepted to manage low risk acute venous thromboembolism (VTE) in the outpatient setting with direct oral anticoagulants (DOACs). Although DOACs are straightforward to dose, they are high risk medications and not immune to medication errors. There is limited evidence that pharmacists’ intervention has an impact on DOAC discharge medication errors in the ED. Objective: To determine if pharmacist involvement reduced the rate of DOAC discharge medication errors in low risk VTE patients. Methods: This retrospective cohort study evaluated a clinical pharmacy service implemented prior to the study. Included patients were evaluated in 2 groups: the cohort with pharmacist involvement and the cohort without pharmacist involvement. The primary outcome was the rate of anticoagulation medication errors. Results: A total of 58 patients were evaluated. Of these patients, 14 had a pharmacist directly involved with their care in the ED while 44 patients did not. The rate of medication errors was lower when a pharmacist was involved, 7.1% (n = 1), compared to when a pharmacist was not involved, 36.4% (n = 16), (p = 0.046). All patients in the pharmacist involvement group received anticoagulation counseling prior to discharge compared to only 56.8% of patients in the non-pharmacist involvement group (p = 0.002). Conclusion: Our protocol for pharmacist involvement at the time of VTE diagnosis during an ED admission showed a reduced rate of anticoagulation medication errors when a pharmacist was involved. This benefit could potentially translate into improved outcomes such as readmission rates, patient safety outcomes, and hospitalizations.

Download Full-text