Pharmacists' confidence when providing pharmaceutical care on anticoagulants a multinational survey
There's a difference with the classical VKA and NOACs' in methods for assessing it and also the consequences of non-adherence due to NOACs’ shorter half-lives. As such, patient monitoring, education, and medication adherence is of critical importance with these novel agents,
This is the first international survey assessing confidence levels of pharmacists when discussing and managing oral anticoagulation therapy and the main purpose of this needs assessment survey was to identify self-reported gaps in knowledge and confidence among pharmacists in the area of anticoagulation and to explore preferred educational methods to close these gaps.
Interested in the international results?
Check out our abstracts/presentations/publications below
Interested in your national data?
Check below if your country already participates and has relevant data. If not, don't hesitate to contact us. We can help you with the translation of the survey and the subanalysis of your national data to present/publish locally!
Participating countries so far
Arabic states (Qatar, Kuwait, UAE, Saudi Arabia)
Main contact: Dr. Filipa Alves da Costa firstname.lastname@example.org
Interprofessional guideline to support patients receiving oral anticoagulation therapy a Delphi consensus statement
International guidelines for the management of thromboembolism are widely available. However, recommendations on the broader spectrum of pharmaceutical anticoagulation care are largely lacking. Through iPACT, an interprofessional guideline to support patients receiving oral anticoagulation therapy was developed.
Based upon the outcome of the Delphi consensus statement, eightteen recommendations form the iPACT guideline and provide the base for optimization of anticoagulation care across different countries and healthcare systems. Future work involves translating the guideline recommendations into clinical practice with an assessment on the impact of patient care.
The guideline is currently under submission.
1. Shared care/ self-management
Patients and their caregivers should have access to appropriate and consistent information and support, in order to make informed choices about the use of oral anticoagulants, the implications of choosing not to take them, and the possibility to self-manage their anticoagulant therapy.
2. Patient communication and engagement
Communication with and the involvement of patients and their caregivers should be considered an integral component of safe and effective pharmaceutical anticoagulant care.
3. Patient education
Patients and their caregivers should be provided with - and at all times have access to - clear, understandable, and evidence-based information on oral anticoagulant therapy to ensure safe and effective use of oral anticoagulants.
4. Therapy plan
To maximize the effect and minimize the risks of therapy, an appropriate individualized therapy plan should be provided to each patient on oral anticoagulants. This therapy plan should be periodically reviewed throughout the course of anticoagulant therapy.
5.Lifestyle, cultural-specific, and clinical aspects
Lifestyle, cultural-specific, and clinical aspects should be taken into account in the management of patients on oral anticoagulant therapy.
6. Adherenceto medication
In patients using oral anticoagulant medication, adherence and persistence to therapy should be assessed and supported. Patients and their caregivers should be educated on adherence.
In patients using VKA’s, the international normalised ratio (INR) should be monitored regularly to ensure safe and effective anticoagulant therapy.
8. Pharmacogenetic assessment
Pharmacogenetic testing may be considered in selected high-risk patients to ensure safe and effective anticoagulant dosing
9. Transfer of care between health care settings
Accurate information about patients’ oral anticoagulant therapy, including current medications, should be transferred accurately between different health care settings to ensure seamless care.
10. Medication reconcilliation and medication review
In patients on oral anticoagulant therapy, medication reconciliation and medication review should be performed on a regular basis to ensure safe, effective, and clinically appropriate use of medication.
11. Medication supply
Patients on oral anticoagulants should have a continuous supply of oral anticoagulants, including appropriate dosing instructions, to ensure safe and effective therapy.
Patients on oral anticoagulant therapy should be offered telemedicine as a service, in order to support them with the use of their anticoagulants and to give them remote access to care.
The incidence (if any), prevalence, and recurrence of oral anticoagulant-related adverse events should be determined, monitored, and reported.
Patients with risk factors (age > 65 years, diabetes, hypertension, or common AF symptoms) not receiving anticoagulant therapy should be routinely screened on AF, and (if needed) referred to a physician for diagnosis
A governance framework (e.g., clinical guidelines, audits, and standard operating procedures (SOPs)) should be developed to ensure safe and effective oral anticoagulant management. This framework (independent from the pharmaceutical industry) should reflect current guidelines, safe practices, and patient surveys
16. Pharmaceutical workforce
The pharmacy team should have the right skill mix, capability, and capacity to develop and provide safe and high-quality services to patients on oral anticoagulant therapy, in order to prevent adverse patient outcomes (e.g., AF-related stroke, haemorrhage, myocardial infarction)
17. Role of specialized pharmacist/ nurse
Specialized pharmacists or nurses should offer ongoing support to patients on oral anticoagulant therapy
18. Continuing Professional Development (CPD)
All pharmaceutical staff involved in anticoagulant care should receive an appropriate level of Continuing Professional Development (CPD), including staff training, ongoing educational development, and documented competency assessment, to ensure safe and effective anticoagulant care
Top 5 recommendations of the iPACT guideline
1. INR-monitoring: patients using VKAs, the international normalized ratio (INR) should be monitored regularly to ensure the safety and effectiveness oforal anticoagulation therapy (OAT).
2. Transfer of care between health care settings: accurate information about patients’ OAT, including current medications, should be transferred accurately between different health care settings to ensure seamless care.
3. Adherence to medication: In patients using oral anticoagulation medication, adherence to and persistence with therapy should be assessed and supported. Patients and their caregivers should be educated on adherence.
4. Patient communication and engagement: communication with and the involvement of patients and their caregivers should be considered an integral component of safe and effective interprofessional OAT-care.
5. Medication reconciliation and medication review: In OAT-patients, medication reconciliation and medication review should be performed on a regular basis to ensure the safe, effective, and clinically appropriate use of medication.
How did we develop this iPACT guideline?
Methods: Two systematic literature searches were performed on existing guidelines on OAT-management and interventions to improve OAT-use. A four-round internet-based Delphi exercise was subsequently conducted with international OAT-experts, to develop interprofessional guideline recommendations. Two broader consultation rounds took place. Items were ranked on a 1 – 10 scale of agreement. Mean and median levels of agreement were reported. A median agreement score of ≥7.5 was considered the threshold for consensus. Level of importance was rated on a 1-3 scale.
Results: Delphi round 1 resulted in a description of 20 domains relevant for interprofessional anticoagulation care. After processing input of both the expert panel and international key opinion leaders (KOLs), the domains were translated into 18 interprofessional guideline recommendations. After Delphi round 2, consensus of opinion was achieved for all recommendations. Median level of agreement varied between 8.5-10.0, whereas mean level of importance was rated between 1.1-2.0 (SD: 0.2-0.7).
Want to implement this guideline in your country?
We can help! We have different tools and best-practices available to help you implement this guideline in your country.
Main contact: Dr. Bart van den Bemt email@example.com
Early detection of Atrial Fibrillation (EDAF) by community pharmacists Know Your Pulse campaign
Atrial fibrillation is the most common cardiac arrhythmia globally, responsible for one third of strokes and often resulting in death or incapacity. This condition, frequently asymptomatic, is estimated to be up to 50% undiagnosed. Reducing this risk with appropriate detection and management strategies offers substantial economic and patient benefits. Both ESC and iPACT recommends (opportunistic) screening for AF by pulse taking or ECG rhythm strip in patients >65 years of age or other risk factors and (if needed) referred to a physician for diagnosis.
Partnership between iPACT and Atrial Fibrillation Association
Since screening for AF is recommended in both ESC and iPACT guidelines, iPACT created a partnership with the Atrial Fibrillation Association (AFA) to test a model whereby pharmacists are actively involved in (opportunistic) screening for AF. It was the largest multi-country ‘Know Your Pulse’ campaign since the creation of the concept by AFA in 2008. The goal was to assess the feasibility of pharmacists implementing pulse checks in community pharmacy to enable identification of new cases of AF and subsequent initiation of anticoagulation. Results are very promising and comparable to other international studies.
Know Your Pulse campaign - iPACT
The partnership is established in 2016, but in two campaigns we were able to involve seventy-eight pharmacies in ten different countries (Canada, Czech Republic, Hong Kong, Hungary, France, New Zealand, Portugal, Spain, Switzerland, United Kingdom) and a total of 2475 patients were screened through a simple 'know your pulse' (either manual or medical device) performed by the community pharmacist. 1,4% percent was diagnosed with AF.
Join the Know Your Pulse campaign 2018 in your country!
The Know Your Pulse campaign 2018 is currently being prepared and we welcome all people who want to support and facilitate the campaign in their country. Whether it's only a pilot case with one pharmacy or a large campaign involving bigger regions, we welcome all the support.
Contact Dr. Filipa Alves da Costa firstname.lastname@example.org
What's in it for you?
In return, you get access to an international validated protocol and the possibility to share best practices with other contributors. National data can be analyzed, published and compared to international data.
Recommendation 14 of the iPACT guideline:
Patients with risk factors (e.g., age > 65 years, diabetes, hypertension, or common AF symptoms) not receiving OAT should be routinely screened on AF, and (if needed) referred to a physician for diagnosis.
1. Screening for AF could be performed by any trained health care provider in primary care settings (e.g., by community pharmacist, and/or general practitioner) as well as by physicians in hospital settings
2. Screening for AF could be carried out by any appropriately validated method, including the use of electronic devices to enhance the reliability of detection (e.g., mobile app)
3. When AF is found to be present at screening, patients should be referred to their treating physician for diagnosis. The health care provider who performed the screening procedure should advise the patient of the risks of not completing the follow-up process
Main contact: Dr. Filipa Alves da Costa email@example.com