Abstract 321: Comparison of Two Models of an Outpatient Anticoagulation Management Service at a Pediatric Medical Center

Abstract

Introduction: Studies and national patient safety organizations recognize benefits of a dedicated warfarin anticoagulation service in maximizing efficacy and minimizing adverse events, hospitalizations and cost. The impact of a pharmacist-led anticoagulation service on adult patient outcomes and health care expenditures has been established, however, similar data is lacking in a pediatric setting. In 2013, the outpatient anticoagulation program within the Heart Institute at Cincinnati Children’s Hospital Medical Center (CCHMC) transitioned from a nurse-managed service model to a pharmacist-managed collaborative service model. This study will describe the differences between a nurse-managed (NM) service model and a pharmacist-managed (PM) service model for outpatient anticoagulation management of cardiology patients followed at a pediatric medical center. Methods: A retrospective study was conducted to evaluate warfarin anticoagulation management of a NM service and PM service at CCHMC. Each service model was reviewed for thirteen months between November 1, 2011 and November 30, 2014. The primary outcomes are percent of time within therapeutic INR range and median time to patient follow-up for INR monitoring (days). Results: Fifty-eight cardiology patients managed by both outpatient anticoagulation services were evaluated during each study group time frame. Median age was 19.1 years (IQR 14.2, 25.7) and 65.5% were male (38 of 58). Of the 58 patients evaluated, 51.7% (30 of 58) were managed within an INR goal range of 2- 3. Most common indications for anticoagulation were cardiac valve replacement (50%; 29 of 58) and Fontan procedure (37.9%; 22 of 58). Percent of time within therapeutic range was 65.7% (12,897 of 19,636 days) for the NM service model and 80.6% (18,650 of 23,131 days) for the PM service model. Percent of time below therapeutic INR range was reduced with the PM model compared to NM model, respectively (12.3% v. 24%). Median time between INR lab draws was 35.1 days (IQR 23.8-73.6) for NM model and 22.3 days (IQR 17.9-26.5) for the PM model. Conclusions: A pharmacist-managed collaborative outpatient anticoagulation service model improved the time within therapeutic range and frequency with INR lab monitoring at a pediatric medical center compared to nurse-managed model.