Abstract
Objective:To identify the facilitators of and barriers to the implementation of Community Pharmacists–Led Anticoagulation Management Services (CPAMS).Data Sources:MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL Register of Controlled Trials were searched from inception until August 20, 2021.Study Selection and Data Extraction:All abstracts proceeded to full-text review, which was completed by 2 reviewers. Data extraction was completed by a single reviewer and verified. Analysis was completed using best-fit framework synthesis.Data Synthesis:A total of 17 articles reporting on CPAMS from 6 jurisdictions were included: 2 Canadian provincial programs (Nova Scotia, Alberta), a national program (New Zealand), and 3 cities in the United Kingdom (Whittington and Brighton and Hove) and Australia (Sydney). Facilitators of CPAMS included convenience for patients, accessibility for patients, professional satisfaction for pharmacists, increased efficiency in anticoagulation management, improved outcomes, enhanced collaboration, and scalability. Barriers included perceived poor quality of care by patients, resistance by general practitioners, organizational limits, capping of the number of eligible patients, and cost.Relevance to Patient Care and Clinical Practice:The barriers and facilitators identified in this review will inform health policy makers on the implementation and improvement of CPAMS for patients and health care practitioners.Conclusion and Relevance:CPAMS has been implemented in 6 jurisdictions across 4 countries, with reported benefits and challenges. The programs were structurally similar in most jurisdictions, with minor variations in implementation. New anticoagulation management programs should consider adapting existing frameworks to local needs.
Highlights
Warfarin has been available and used for the prevention and treatment of thromboembolic events for more than 70 years.[1]
Anticoagulation services were traditionally provided by physicians in collaboration with onsite or off-site laboratories.[3]
A total of 133 studies were excluded for the following reasons: not relevant (n = 75), not Community Pharmacists–Led Anticoagulation Management Services (CPAMS) (n = 26), duplicate (n = 19), and did not provide an overview of program, implementation or evaluation (n = 12; Figure 1)
Summary
Warfarin has been available and used for the prevention and treatment of thromboembolic events for more than 70 years.[1] It has been shown to reduce the risk of stroke in patients with atrial fibrillation by 60%.1. To better manage warfarin therapy, some jurisdictions have established specialized anticoagulation clinics.[1,2] These anticoagulation management services (AMSs) are provided by health care professionals such as doctors, nurses, and pharmacists, independently or collaboratively. Anticoagulation services were traditionally provided by physicians in collaboration with onsite or off-site laboratories.[3] patient-centered models, such as self-testing and self-management, are emerging alternatives that allow those on warfarin to be more involved with their own care.
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