Pharmacist Anticoagulation Program Increases Patient Satisfaction

Survey results from Henry Ford Hospital in Detroit suggest that an inpatient pharmacist-directed anticoagulation service increases patient satisfaction and may boost Medicare reimbursement as well.

Anticoagulation services directed by a team of pharmacists appear to significantly increase patient satisfaction scores compared with conventional services directed by a primary care team with access to a clinical pharmacist, according to the results of a study published online on May 8, 2013, in the Annals of Pharmacotherapy.

Since 2008, inpatient anticoagulation services at Henry Ford Hospital in Detroit have been directed by a team of pharmacists that is responsible for dosing, monitoring, and educating all hospitalized patients receiving anticoagulants (including warfarin) and making sure that patients transition safely from the hospital to an outpatient setting on discharge. Pharmacists on the team also determine doses for patients receiving direct thrombin inhibitors and monitor patients receiving enoxaparin, heparin, and the new oral anticoagulants, adjusting doses as needed.

Pharmacists on the team receive extensive initial training in anticoagulation, undergo periodic assessment of their anticoagulation management competency, and spend all their time attending to patients receiving anticoagulation. (Previously, any pharmacist could provide patient education regarding anticoagulation.) As a result, risk of bleeding and thrombosis has decreased by 5%, and the success rate of patients transitioning from hospital to outpatient settings has been greater than 70%.

For the current study, a research team led by James Kalus, PharmD, senior clinical pharmacy manager at Henry Ford Hospital, conducted a survey of patients who received inpatient anticoagulation therapy at the hospital to determine how the pharmacist-directed anticoagulation service (PDAS) had affected patient satisfaction. Surveys were mailed to 1694 patients after discharge, and 687 responded. Results were compared for patients treated under the conventional model from February 2001 through April 2007 with those treated under the PDAS model from December 2008 through December 2010. (Of 1245 patients treated using the conventional model, 528 responded; of 449 patients treated under the PDAS model, 159 responded.)

The results of the 5-question survey indicated that, under the PDAS model, patients’ overall satisfaction with medical care increased 10.6%, satisfaction with the amount of information communicated to patients increased 37.2%, satisfaction with the clarity of communication regarding drug therapy increased 35.2%, and satisfaction with the quality of answers to patient questions increased 29.5%. In addition, 71.1% of those treated under the PDAS model recalled speaking with a pharmacist during their hospital stay, compared with 28.0% of those treated under the conventional model. Within the PDAS treatment group, those who recalled speaking with a pharmacist reported significantly higher levels of satisfaction with their treatment than those who did not.

“These results suggest that more formalized patient care roles for pharmacists could be associated with improved patient satisfaction overall and with improved quality and quantity of information received about medications,” the researchers write.

With the implementation of the Affordable Care Act, the Centers for Medicare and Medicaid Services has begun using patient satisfaction data as measured using the Hospital Computer Assessment of Healthcare Providers and Systems (HCAHPS) to help determine Medicare reimbursement levels.

“Measures similar to those used in our study are captured with the HCAHPS survey,” the researchers write. “Although HCAHPS questions do not wholly measure pharmacist activities, one interpretation of our data could be that hospitals deploying focused programs with systematic approaches to patient-pharmacist communication could see an impact on HCAHPS performance. Therefore, our study provides a compelling example of what pharmacy departments and hospital administrators may consider when redesigning health care delivery models in an era of hospital value-based purchasing.”