Hospital admission rates of patients enrolled in pharmacist vs nurse anticoagulation management services

Abstract

IntroductionVarious health care professionals provide dedicated anticoagulation management services (AMS). There is limited literature describing head‐to‐head trials comparing outcomes among different types of AMS.ObjectivesThe primary objective is to compare all‐cause hospitalizations between pharmacist‐ and nurse‐managed AMS. The secondary objectives are to characterize admissions, readmissions, and emergency department visits.MethodsThis study is a retrospective, observational cohort. Patients were included if they were 18 y of age or older and had an anticoagulation management consult for either the pharmacist‐ or nurse‐managed anticoagulation clinics from July 1, 2013 to June 30, 2014. Patients were excluded if they had a lapse of 10 wk without a point‐of‐care International normalized ratio draw or had a duration of warfarin management less than 2 wk. The study period included the duration of warfarin management or up to 1 y of warfarin management after the initial consult, whichever was shorter.ResultsA total of 824 and 547 patients were identified in the pharmacist‐ and nurse‐managed groups, respectively. A total of 250 patients were randomized in each arm. After accounting for exclusion criteria, 242 and 245 patients were included in the pharmacist‐ and nurse‐managed groups, respectively. Baseline characteristics differed between the groups based on poverty status, race, stroke risk score, previous admissions, and international status. The primary outcome occurred in 55 (22.7%) of the pharmacist‐managed patients and 86 (35%) of the nurse‐managed patients (P = 0.002). When accounting for differences in baseline characteristics, there was a statistically significant decrease in all‐cause hospitalizations in the pharmacist group (odds ratio = 0.63; 95% confidence interval [0.39‐0.98]). Indication for warfarin, types of admissions, emergency department visits, and 30‐d readmissions was similar between the groups. Time in therapeutic range was different between the groups.ConclusionThis hypothesis‐generating study found a difference in AMS performed by pharmacists and nurses. Pharmacists reduced hospitalization rates within the first year of AMS.