Care Transitions in Anticoagulated Patients: The Health-System Pharmacist's Role

Health-system pharmacists can play a pivotal role in ensuring medication adherence among anticoagulated patients during transitions of care (TOC).

In a session dedicated to this topic at the American Society of Health-System Pharmacists’ 2015 Summer Meetings and Exposition in Denver, John Moorman, PharmD, BCPS, of the Department of Pharmacy Practice at Northeast Ohio Medical University, said pharmacists can implement a number of interventions to safeguard a TOC program’s success.

In fact, studies have shown pharmacist-led interventions are successful in supporting patient adherence to novel oral anticoagulants (NOACs) and improving health outcomes.

One such study demonstrated adherence rates for atrial fibrillation patients taking the NOAC dabigatran (Pradaxa) were stronger among those participating in a pharmacist-driven drug management program. This outcome was attributed to pharmacists’ ability to provide education regarding medication adherence, examine any possible drug interactions, follow-up to ensure patients are sticking to their regimens, and confirm prescriptions are refilled on time.

Mollie Ashe Scott, PharmD, regional associate dean for the Asheville campus of the UNC Eshelman School of Pharmacy, exclusively told Pharmacy Times about her health-system’s approach to a pharmacist-led TOC program for patients taking NOACs.

“[Mountain Area Health Education Family Health Center] has some automated systems in place where patients who are in our hospital system will transition to the pharmacist for management of anticoagulation, perhaps before they even see their physician, in order to get that plan implemented and ensure safety of the use of anticoagulants,” Dr. Scott explained.

In this particular TOC model, pharmacists are tasked with giving patients an overview of their anticoagulant treatment plan.

“As the patient is being discharged, regardless of what anticoagulant they’re on, the system gets them in front of a pharmacist embedded within the clinic for follow-up, for education, for issues with adherence, for issues with cost, for development of the monitoring plan over time, and to develop a stop date in terms of the length of therapy,” Dr. Scott said.

Personalized attention from a pharmacist is especially important when considering the number of anticoagulants currently available and deciding which treatment regimen is most appropriate for a particular patient.

“[Comparing NOACs] with warfarin is a very important conversation because there’s not a one-size-fits-all strategy with those particular therapies,” Tom Frank, PharmD, BCPS, of the Department of Pharmacy Practice at the University of Arkansas for Medical Sciences, told Pharmacy Times in an exclusive interview at the ASHP 2015 Summer Meetings.

For instance, patients may be more likely to remain compliant with their anticoagulant treatment regimen if it is relatively convenient. This is one strength of NOACs like edoxaban (Savaysa), which “offers the convenience of once-daily dosing, no need for routine blood monitoring, and the flexibility to be taken with or without a meal,” Howard Rutman, MD, vice president of medical affairs for the drug’s manufacturer, Daiichi Sankyo, told Pharmacy Times in an e-mail.

For many anticoagulated patients, adherence is also dependent on treatment costs, and the results of a sub-group analysis from the Hokusai-VTE trial presented in a poster at the ASHP 2015 Summer Meetings suggest edoxaban is a cost-saving alternative to warfarin.

Still, Dr. Frank said, “the price tag [for NOACs] is about $10 a day.”

Cost aside, “NOACs are desirable [for patients] because 2 hours after you take the first dose, you are anticoagulated,” he said.

Regardless of which NOAC is ultimately selected, Dr. Frank said “it’s imperative that [health-system pharmacists] have a level of communication and access for the patients in order to predispose them to success with this very important therapeutic tool.”

“It’s really about safety,” Dr. Scott said of TOC programs for anticoagulated patients. “And pharmacists have a great role in that.”