A novel model of care in anticoagulation management

2020 ◽  
Vol 33 (6) ◽  
pp. 247-252
Author(s):  
Lisa Woodill ◽  
Allison Bodnar
Keyword(s):  
Point Of Care ◽  
Healthcare Providers ◽  
Decision Support Tool ◽  
International Normalized Ratio ◽  
Blood Collection ◽  
Management Service ◽  
Model Of Care ◽  
Anticoagulation Management ◽  
Support Tool ◽  
Care Community

For over 60 years, warfarin has been the treatment of choice in the prevention of strokes and other thromboembolic events. In recent years, a new class of Novel Oral Anticoagulant (NOAC) medication has become available, leaving clinicians and health system payors to question whether warfarin continues to have a place in therapy. This article argues that it may not be the medication that should be in question but instead the systems in place to manage anticoagulation for the patients who need it. Usual Care (UC) for warfarin management has traditionally required multiple healthcare visits, blood collection visits, and laboratory analysis of International Normalized Ratio (INR) with results to then later be relayed to the patient along with dosage adjustments. The article reviews a new model of care, Community Pharmacist-led Anticoagulation Management Service (CPAMS), in which patients receive a point-of-care INR test along with a pharmacist assessment at a pharmacy and results within minutes. Pharmacists then prescribe dosage adjustments immediately, counsel patients, and provide supporting adherence tools such as a colourful picture-based dosing calendar, created by the decision support tool, INR Online. The Nova Scotia CPAMS Demonstration Project shows that this model will result in efficiencies for healthcare providers and optimal anticoagulation with improved time in therapeutic range outcomes for patients. In addition, the CPAMS Costing Study finds the model to be a cost-effective solution for health systems when compared to UC for warfarin as well as NOAC patients.

scholarly journals Applicability of Pharmacogenomically Guided Medication Treatment during Hospitalization of At-Risk Minority Patients

2021 ◽  
Vol 11 (12) ◽  
pp. 1343
Author(s):  
Loren Saulsberry ◽  
Keith Danahey ◽  
Merisa Middlestadt ◽  
Kevin J. O’Leary ◽  
Edith A. Nutescu ◽  
...  
Keyword(s):  
At Risk ◽  
Point Of Care ◽  
Healthcare Providers ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Support Tool ◽  
Implementation Program ◽  
Populations At Risk ◽  
Toxicity Risk ◽  
Predominantly Female

Known disparities exist in the availability of pharmacogenomic information for minority populations, amplifying uncertainty around clinical utility for these groups. We conducted a multi-site inpatient pharmacogenomic implementation program among self-identified African-Americans (AA; n = 135) with numerous rehospitalizations (n = 341) from 2017 to 2020 (NIH-funded ACCOuNT project/clinicaltrials.gov#NCT03225820). We evaluated the point-of-care availability of patient pharmacogenomic results to healthcare providers via an electronic clinical decision support tool. Among newly added medications during hospitalizations and at discharge, we examined the most frequently utilized medications with associated pharmacogenomic results. The population was predominantly female (61%) with a mean age of 53 years (range 19–86). On average, six medications were newly prescribed during each individual hospital admission. For 48% of all hospitalizations, clinical pharmacogenomic information was applicable to at least one newly prescribed medication. Most results indicated genomic favorability, although nearly 29% of newly prescribed medications indicated increased genomic caution (increase in toxicity risk/suboptimal response). More than one of every five medications prescribed to AA patients at hospital discharge were associated with cautionary pharmacogenomic results (most commonly pantoprazole/suboptimal antacid effect). Notably, high-risk pharmacogenomic results (genomic contraindication) were exceedingly rare. We conclude that the applicability of pharmacogenomic information during hospitalizations for vulnerable populations at-risk for experiencing health disparities is substantial and warrants continued prospective investigation.

scholarly journals Community Pharmacy Marketing: Strategies for Success

2011 ◽  
Vol 2 (3) ◽  
Author(s):  
Kristina D. Wood ◽  
Megan Offenberger ◽  
Bella H. Mehta ◽  
Jennifer L. Rodis
Keyword(s):  
Target Population ◽  
Outpatient Setting ◽  
Marketing Strategies ◽  
Community Pharmacies ◽  
Management Service ◽  
Clinical Services ◽  
Anticoagulation Management ◽  
Care Community ◽  
The Ohio State University ◽  
Targeted Marketing

Purpose: As community pharmacies are implementing increasingly more clinical services they are faced with a new challenge of marketing these services. This article discusses The Ohio State University College of Pharmacy Clinical Partners Program's (Clinical Partners) experiences in marketing clinical services to patients, barriers encountered through these experiences, and presents suggestions for future marketing of services. Experience: Clinical Partners developed two targeted marketing projects and evaluated impact on patient enrollment in services. In January 2008, the pharmacy ran a series of radio advertisements, newspaper print advertisements, and face to face marketing in the community with the focus of each being patient care services. During this project five individuals expressed interest in Clinical Partners' services. Four indicated that they heard about Clinical Partners through the radio ad and one through the pharmacy website, though none chose to enroll in services. In 2009 Clinical Partners focused on marketing MTM in the form of a comprehensive medication review to current patients already enrolled in its anticoagulation management service. Following a three month period, 6 patients (8%) of the 71 patients receiving the marketing intervention chose to enroll in MTM. Four additional patients have enrolled in MTM since conclusion of the project. Discussion: These projects and a review of available literature revealed barriers that pharmacies encounter when marketing clinical services to patients in an outpatient setting including patients' unawareness of the role a pharmacist can play outside dispensing medications, patients' belief they do not need clinical services, and patients' unwillingness to pay a pharmacist out of pocket for services. Future Implications: To overcome these identified challenges, community pharmacies should consider integration of marketing techniques such as tailoring marketing to a target population, forming and utilizing relationships with patients, and looking to past marketing successes in developing marketing plans. Pharmacists should also be adventurous in exploring new ways to promote pharmacy clinical services to find creative solutions to barriers encountered. As community pharmacies continue to grow the realm of clinical services offered to patients, it is important also to develop and implement marketing strategies to support the services and expansion of the profession so that these services can be embraced by patients and the health care community.   Type: Idea paper

Red Book Point-of-Care Clinical Decision Support Tool

2018 ◽  
Keyword(s):  
Decision Support ◽  
Infectious Diseases ◽  
Clinical Decision Support ◽  
Health Care Professionals ◽  
Point Of Care ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Support Tool ◽  
Pediatric Health Care ◽  
Flip Chart

This convenient flip chart provides pediatric health care professionals with point-of-care guidance on the assessment, prevention, and treatment of childhood infectious diseases. https://shop.aap.org/red-book-pediatric-infectious-diseases-clinical-decision-support-chart/

scholarly journals LO22: Implementation of an electronic clinical decision support tool to improve knowledge translation and imaging appropriateness for patients with mild traumatic brain injury and suspected pulmonary embolism

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S34-S35
Author(s):  
J. Andruchow ◽  
D. Grigat ◽  
A. McRae ◽  
G. Innes ◽  
E. Lang
Keyword(s):  
Pulmonary Embolism ◽  
Decision Support ◽  
Point Of Care ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Evidence Based ◽  
Support Tool ◽  
Imaging Appropriateness ◽  
Ct Head ◽  
Evidence Based Guidelines

Introduction/Innovation Concept: Utilization of CT imaging has increased dramatically over the past two decades, but has not necessarily improved patient outcomes. As healthcare spending grows unsustainably and evidence of harms from unnecessary testing accrues, there is pressure to improve imaging appropriateness. However, prior attempts to reduce unnecessary imaging using evidence-based guidelines have met with limited success, with common barriers cited including a lack of confidence in patient outcomes, medicolegal risk, and patient expectations. This project attempts to address these barriers through the development of an electronic clinical decision support (CDS) tool embedded in clinical practice. Methods: An interactive web-based point-of-care CDS tool was incorporated into computerized physician order entry software to provide real-time evidence-based guidance to emergency physicians for select clinical indications. For patients with mild traumatic brain injury (MTBI), decision support for the Canadian CT Head Rule pops up when a CT head is ordered. For patients with suspected pulmonary embolism (PE), the tool is triggered when a CT pulmonary angiogram is ordered and provides CDS for the Pulmonary Embolism Rule-out Criteria (PERC), Wells Score, age-adjusted D-dimer and CT imaging. To study the impact of the tool, all emergency physicians in the Calgary zone were randomized to receive voluntary decision support for either MTBI or PE. Curriculum, Tool, or Material: The tool uses a multifaceted approach to inform physician decision making, including visualization of risk and quantitative outcomes data and links to primary literature. The CDS tool simultaneously documents guideline compliance in the health record, generates printable patient education materials, and populates a REDCap™ database, enabling the creation of confidential physician report cards on CT utilization, appropriateness and diagnostic yield for both audit and feedback and research purposes. Preliminary data show that physicians are using the MTBI CDS approximately 30% of the time, and the PE CDS approximately 40% of the time. Evaluation of CDS impact on imaging utilization and appropriateness is ongoing. Conclusion: A voluntary web-based point-of-care decision support tool embedded in workflow has the potential to address many of the factors typically cited as barriers to use of evidence-based guidelines in practice. However, high rates of adherence to CDS will likely require physician incentives and appropriateness measures.

Twenty-two percent less water on maize with a new subscriber decision support tool

2014 ◽  
Vol 9 (1) ◽  
pp. 115-123
Author(s):  
Bertrand Pinel ◽  
Marianne Moalic
Keyword(s):  
Decision Support ◽  
Water Use ◽  
Irrigation System ◽  
New Technology ◽  
Irrigation Management ◽  
Decision Support Tool ◽  
Management Service ◽  
Management Tools ◽  
Support Tool ◽  
Pump Speed

As a case study, this paper shows how a French cooperative seized on a new technology (capacitance sensors), tested it in real conditions (irrigation of maize in several Agronomic Department trial fields) and is now able to offer to its farmer members a subscriber decision support tool (DST) to increase water use efficiency. Thus, technical and scientific trials have been conducted with fourteen farmers over the last four years. Managing irrigation with capacitance probes has resulted in an increase in water efficiency: most of the time, there is a reduction in water supply (the average is 22% (range 4–44%) less water use than without the probes). Sometimes, only a yield increase is observed with the same water quantity (see 2010 trial – farmer 2). In 2012 Terrena conducted market research on 28 farmer members and 20 crop advisors. This showed that most farmers who irrigate do not use irrigation management tools. However with a tightening of regulations and an increase in irrigation costs, attitudes are changing. Thus, 12 farmers questioned, said they were ready to pay for an irrigation management service based on capacitance probes (continuous real time monitoring of soil moisture). It also showed that irrigation advice needs to take into account global irrigation system constraints (number of rollers, pump speed and the like). Farmers are ready to pay for an efficient irrigation management DST. So as to be ready for a 2013 launch, a DST soft-launch was set-up in 2012 on ten experimental farms. The usual working practices of irrigators cannot be expected to change overnight. However, this study shows how important is the farmers' involvement in the building of this service, coupled with that of their crop advisors. Because farmers were involved at the beginning of the DST creation process, it made it possible to convince all of them to use this tool in a more sustainable manner.

scholarly journals Utilization and uptake of the UpToDate clinical decision support tool at the Makerere University College of Health Sciences (MakCHS), Uganda

2021 ◽  
Vol 21 (2) ◽  
pp. 904-911
Author(s):  
Alison Annet Kinengyere ◽  
Julie Rosenberg ◽  
Olivia Pickard ◽  
Moses Kamya
Keyword(s):  
Clinical Practice ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Point Of Care ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Health Sciences ◽  
Support Tool ◽  
Makerere University ◽  
Clinical Decision Support Tool

Background: The use of point-of-care, evidence-based tools is becoming increasingly popular. They can provide easy-to- use, high-quality information which is regularly updated and has been shown to improve clinical outcomes. Integrating such tools into clinical practice is an important component of improving the quality of health care. However, because such tools are rarely used in resource-limited settings, there is limited research on uptake especially among medical students. Objective: This paper explores the uptake of one such tool, Up-To-Date, when provided free of cost at a medical school in Africa. Methods: In partnership with the Better Evidence at Ariadne Labs free access to UpToDate was granted through the MakCHS IP address. On-site librarians facilitated training sessions and spread awareness of the tool. Usage data was aggre- gated, based on log ins and content views, presented and analyzed using Excel tables and graphs. Results: The data shows evidence of meaningful usage, with 43,043 log ins and 15,591 registrations between August 2019 and August 2020. The most common topics viewed were in obstetrics and gynecology, pediatrics, drug information, and infectious diseases. Access occurred mainly through the mobile phone app. Conclusion: Findings show usage by various user categories, but with inconsistent uptake and low usage. Librarians can draw upon these results to encourage institutions to support uptake of point-of-care tools in clinical practice. Keywords: UpToDate clinical decision support tool; Makerere University College of Health Sciences; Uganda.

scholarly journals Prehospital risk stratification in patients with chest pain

2021 ◽  
pp. emermed-2020-210212
Author(s):  
Dennis Sagel ◽  
Pieter Jan Vlaar ◽  
Radboud van Roosmalen ◽  
Ingmar Waardenburg ◽  
Wybe Nieuwland ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Predictive Value ◽  
Point Of Care ◽  
Characteristic Curve ◽  
Decision Support Tool ◽  
Cardiac Risk ◽  
Prehospital Setting ◽  
Support Tool ◽  
Heart Score

ObjectivesThe History, ECG, Age, Risk Factors and Troponin (HEART) Score is a decision support tool applied by physicians in the emergency department developed to risk stratify low-risk patients presenting with chest pain. We assessed the potential value of this tool in prehospital setting, when applied by emergency medical services (EMS), and derived and validated a tool adapted to the prehospital setting in order to determine if it could assist with decisions regarding conveyance to a hospital.MethodsIn 2017, EMS personnel prospectively determined the HEART Score, including point-of-care (POC) troponin measurements, in patients presenting with chest pain, in the north of the Netherlands. The primary endpoint was a major adverse cardiac event (MACE), consisting of acute myocardial infarction or death, within 3 days. The components of the HEART Score were evaluated for their discriminatory value, cut-offs were calibrated for the prehospital setting and sex was substituted for cardiac risk factors to develop a prehospital HEART (preHEART) Score. This score was validated in an independent prospective cohort of 435 patients in 2018.ResultsAmong 1208 patients prospectively recruited in the first cohort, 123 patients (10.2%) developed a MACE. The HEART Score had a negative predictive value (NPV) of 98.4% (96.4–99.3), a positive predictive value (PPV) of 35.5% (31.8–39.3) and an area under the receiver operating characteristic curve (AUC) of 0.81 (0.78–0.85). The preHEART Score had an NPV of 99.3% (98.1–99.8), a PPV of 49.4% (42.0–56.9) and an AUC of 0.85 (0.82–0.88), outperforming the HEART Score or POC troponin measurements on their own. Similar results were found in a validation cohort.ConclusionsThe HEART Score can be used in the prehospital setting to assist with conveyance decisions and choice of hospitals; however, the preHEART Score outperforms both the HEART Score and single POC troponin measurements when applied by EMS personnel in the prehospital setting.

Sign in / Sign up

Export Citation Format

Share Document