Developing Pharmacist-Led Anticoagulation Clinics in Primary Care Settings: A Multi-Phase Mixed-Methods Study

Abstract

Background: Primary care is an integral part of the healthcare system. Patients have better accessibility and continuity of care. However, studies have reported low-quality warfarin management in these settings. Pharmacist-led anticoagulation clinics have evolved as an effective practice to improve anticoagulation control. Pharmacists demonstrated better outcomes than usual care. Hence, we aimed to assess the rationale and feasibility of implementing a pharmacist-led anticoagulation clinic in the primary care settings in Qatar. Methodology: A multiphase mixed-methods design was conducted between June and October 2023. The first phase was a retrospective study that assessed the quality of warfarin management by measuring the percentage of time-in-therapeutic range (TTR) and the percentage of extreme out-of-range INR readings. In phase two, a convergent mixed-methods study was conducted to explore the perception of key stakeholders about implementing the clinic and to determine the essential components of the clinic implementation. The quantitative strand explored the perceptions of patients, pharmacists, and physicians at PHCC through an online survey. The qualitative strand was a semi-structured interview with the key informant at the PHCC. Inferential and descriptive analyses were performed as appropriate. Results: The mean (SD) TTR for the 494 patients included in the study was 45.33% (17.52%), which was lower than the recommended value of 70% (P<0.001). Both pharmacists and physicians have recognized the significance of the clinic. Patients generally have confidence in the service's ability to improve their health, with most believing that pharmacists would have the ability to provide safe and effective care. Key informants emphasized the importance of optimizing the management of patients on warfarin. They strongly believed in the proposed clinic to address the patients’ needs. The main identified facilitators were ensuring pharmacists’ competency and establishing effective communication. Staff shortages were identified as the primary obstacles to the clinic's implementation. Conclusions: The findings of this study provide strong support for establishing a pharmacist-led anticoagulation clinic in primary care settings. Stakeholders believe that this model can serve as an effective strategy to address the existing shortcomings in anticoagulation management in primary care settings. Tailoring the service to the PHCC context, fully leveraging the strengths of facilitators, and overcoming obstacles are crucial to ensure the success of the clinic implementation.