RESUMO
Background: Anticoagulation therapy is crucial for managing various cardiovascular and thrombotic conditions; however, optimal delivery remains challenging in primary care. Pharmacist-led anticoagulation services have emerged as a potential strategy for enhancing patient care and outcomes in such settings. Understanding the perspectives of key stakeholders is critical for successful implementation. Objectives: This study aimed to explore the perceptions of key stakeholders involved in the implementation of pharmacist-led anticoagulation clinics in primary care settings. Methods: A cross-sectional study was conducted using structured, pilot-tested questionnaires between August and October 2023. Patients receiving warfarin, pharmacists, and physicians working across various primary healthcare centres were invited to complete an online survey. Each group of stakeholders had individualised questionnaires to assess their perceptions and expectations with regard to developing pharmacist-led anticoagulation clinics in primary care. Descriptive statistics were used to analyze the data. Results: The response rates for the survey were 29.4% for physicians, 10.4% for patients, and 48.6% for pharmacists. Participants expressed positive perceptions toward pharmacist-led anticoagulation clinics, acknowledging benefits such as improved access to care, enhanced medication management, and increased patient education. The respondents expressed confidence in the expertise and skills of pharmacists in this role. However, healthcare providers strongly agree that pharmacists should receive additional training specific to anticoagulation management. Establishing standardised protocols and fostering interprofessional collaboration were identified as the main facilitators for practical implementation. Conclusions: Broad support exists for pharmacist-led anticoagulation clinics in primary care, though additional pharmacist training and accountability concerns need to be addressed for successful implementation.
RESUMO
BACKGROUND: Warfarin management is associated with severe complications, highlighting the critical need to evaluate the quality of its administration. OBJECTIVES: To evaluate the quality of warfarin management for patients managed in primary healthcare centers by measuring the percentage of Time in Therapeutic Range (TTR) and the proportion of extreme out-of-range international normalized ratio (INR) values. METHODS: This is a cross-sectional study. Data was extracted from a national dataset retrieved from the largest primary healthcare provider in Qatar. TTR was calculated using the traditional method. Inferential and descriptive analyses were performed as appropriate. RESULTS: Four hundred ninety-four patients met the inclusion criteria. The mean (SD) TTR was 45.3 % (17.5). This was significantly lower than the recommended cutoff value (P<0.001). Extreme out-of-range INR accounted for 24.7 % of total INR readings. CONCLUSIONS: The management of patients taking warfarin in Qatar is inadequate. More effective strategies are warranted to ensure safe and effective therapy.