The Quality of Advice Provided by Pharmacists to Patients Taking Direct Oral Anticoagulants: A Mystery Shopper Study

Jonathon Ertl,Leanne Chalmers,Luke Bereznicki

doi:10.3390/pharmacy8030164

Jonathon Ertl, Leanne Chalmers + Show 1 more

Open Access

https://doi.org/10.3390/pharmacy8030164

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Abstract

Pharmacists report being less confident in their knowledge of direct acting oral anticoagulants (DOACs) than of vitamin K antagonists, which may influence their ability to detect and manage complications arising from DOAC use. In a mystery shopper study, patient agents were sent into community pharmacies with symptom or product-related requests related to common complications that might arise during treatment with oral anticoagulants, with each visit being assessed for the preferred outcome. Only 10/41 (24.4%) visits resulted in the preferred outcome. A complete history-taking process, obtaining a medical history, patient characteristics and pharmacist involvement were strong predictors of the preferred outcome being achieved. The preferred outcome was not consistently achieved without pharmacist involvement. The potential for strategies that support comprehensive pharmacist involvement in over-the-counter requests should be considered to ensure the provision of optimal care to patients taking high-risk medications such as DOACs.

Highlights

Oral anticoagulation is required in patients with atrial fibrillation (AF) due to the increased risk of thromboembolic events, mainly stroke [1,2]
Adverse effects are common in patients taking oral anticoagulant (OAC) and, due to knowledge gaps, patients may rely on pharmacists and other healthcare professionals to identify and manage them [7,8]
In many cases, the pharmacist or pharmacy assistant conducted the interaction without the knowledge the patient was taking a direct oral anticoagulants (DOACs)

Summary

Introduction

Oral anticoagulation is required in patients with atrial fibrillation (AF) due to the increased risk of thromboembolic events, mainly stroke [1,2]. Patients taking DOACs have been reported to have sub-optimal knowledge regarding their anticoagulant therapy relative to the level of knowledge observed among patients taking warfarin [7]. Potential explanations for this include fewer healthcare professional interactions and less intensive counselling when commencing the medication [7]. Pharmacists have reported being less confident in their knowledge of DOACs than VKAs [9]. This might be hypothesised to negatively impact the education provision to patients taking DOACs and potentially lead to a suboptimal detection rate of OAC adverse effects

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