Anticoagulation clinics poor training grounds
Survey finds one-fourth of clinics offer training
A survey of 110 pharmacist-run anticoagulation clinics in 42 states found that few clinics offer training or credentialing, justifying the call from payers that standards should be in place before reimbursement can expand.
Conducted by pharmacists at the University of Washington Medical Center in Seattle and the university's College of Pharmacy, the survey found that just 25 of the 110 respondents (23%) offer a training program for pharmacists.
Equally low was the number of clinics that housed pharmacists who had completed an outside training program, such as the voluntary Anticoagulation Service Traineeship program, which the American Society of Health-System Pharmacists in Bethesda, MD, established in 1986. Overall, 32 of the 110 clinics had at least one pharmacist who had completed the program, eight from within the 25 responding clinics that did offer training, and 24 from the 85 clinics that did not. Sixty percent of responding clinics offered outpatient care only, while 40% featured both inpatient and outpatient care. Half of the respondents were from Veterans Affairs medical centers.
Of the 25 clinics that did offer training, the surveyors found that 23 included didactic components in their programs, including case studies, lectures, computer software, and video and audio tools. Twenty-three of 25 also covered experiential tools, such as physical diagnostic skills, finger-stick techniques and venipuncture tech - niques, among other training areas. Finally, the survey's authors note that 21 of the 25 clinics offering training used both didactic and experiential methods for training and/or credentialing.
Also, within the 25 clinics undertaking training programs, 22 reported regular performance assessments by peer review (77%), observation (41%), physician audit (23%), or combinations, although only six clinics required recertification either annually or every two years. Clinical duties granted after training primarily included dosage adjustment, the ordering of lab tests, prescribing, finger-stick procedures, and ordering vitamin therapy.
The overall numbers troubled the survey's authors, although they noted that anticoagulation clinics have achieved positive patient outcomes cost-effectively. Still, "for anticoagulation management to be successful, patient education interpretation of the INR [international normal ized ratio], dosage adjustments, and patient follow-up are required," says Jennifer Mehlberg, PharmD, clinical pharmacist at the university's medical center. "Success ful therapy also requires experience in the man age ment of hemorrhagic complications and specialized knowledge of the pharmacokinetic and pharmacodynamic properties of warfarin. Phar ma cists who provide this type of care need to be skilled in various aspects of anticoagulation management. However, education and credentialing providers have not been standardized or evaluated." The authors also point out that their survey does not compare patient outcomes or the quality of care patients are getting from trained and credentialed vs. untrained pharmacists.
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