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)
Argentina
Australia
Belgium
Brazil
Canada
Croatia
Czech Republic
England
France
Germany
Hungary
Ireland
New Zealand
Portugal Slovakia
Spain
The Netherlands
Main contact: Dr. Filipa Alves da Costa filipa.alvesdacosta@ipact.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.
18 recommendations
Title
Mainrecommendation
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.
7. INR-monitoring
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.
12. Telemedicine
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.
13. Pharmacovigilance
The incidence (if any), prevalence, and recurrence of oral anticoagulant-related adverse events should be determined, monitored, and reported.
14. Screening
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
15. Governance
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 bart.vandenbemt@ipact.org
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 filipa.alvesdacosta@ipact.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 filipa.alvesdacosta@ipact.org
Posters Detect Protect Correct (DPC) and Know Your Pulse (KYP) (Found: 26)
In this section you will find two models of posters to display at the venue where you will be holding the awareness campaign. You can use both models simultaneously or choose one of them.
Take the Pulse Check Challenge/KYP - AliveCor A5 - English
White Paper on inequalities and unmet needs in the detection of atrial fibrillation (AF) and use of therapies to prevent AF‑related stroke in Europe
This report was developed by The Health Policy Partnership in collaboration with a group of expert contributors, with funding from the BMS–Pfizer Alliance. For full details see page 2.
Real-world observational data confirm the efficacy of atrial antitachycardia pacing in terminating slow and regular atrial tachyarrhythmias in patients wearing implantable cardiac electronic devices
Author: G. Boriani, , S. Iacopino , F. De Rosa, , A. Proclemer, , T. Infusino, , M. Biffi, , A. Capucci, , E. Pisano, , G. Zanotto
Value of Pharmacists in detecting atrial fibrillation during World Heart Rhythm Week
Author: F. Alves Da Costa, S. Antoniou, , J. Papastergiou,, M. Dolores Murillo, , T. Lobban,, K. Ladova, , V. WY Lee, , H. Williams, , D. Griffiths,, S. Tous,, N. Breakwell, , M.-C. Chaumais
Identifying the undiagnosed AF patient through “Know Your Pulse” community pharmacy based events held in ten countries during Arrhythmia Alliance World Heart Rhythm Week 2017
Atrial fibrillation (AF) is the most common arrhythmia, it is frequently asymptomatic with a third of people with AF currently undiagnosed. A manual pulse rhythm check can help improve detection rates and use of mobile ECG technology can help in its diagnosis.
Previous studies have shown the value of Community Pharmacy in helping to opportunistically screen for people with various conditions including AF.
Arrhythmia Alliance (A-A) hosts the annual Arrhythmia Alliance World Heart Rhythm Week and the campaign theme was “identifying the undiagnosed person with arrhythmia”.
Author: T Lobban N Breakwell N Hamedi S Antoniou F Alves De Costa S Tous J Papastergiou F Derango D Griffiths M.-C Chaumais R Viola K Ladova E Paulino K Hersberger B Freedman Arrhythmia Alliance
A member can submit a proposal for a project to the DRM-F Board. To be approved, the proposal must be in line with the mission and values of DRM-F listed below. The board will provide feedback on the application within a 2 month time frame period. Please review the "Process of Submission and Approval" section for more information.
A member can submit a proposal for a project to the DRM-F Board. This proposal should be in line with the mission and values of DRM-F. The following principles will apply to all projects:
Must be Aligned to the strategic imperatives of IPACT.
Must demonstrate a global impact.
Must be conducted in an open and transparent manner.
Confidentiality of information received in the course of the arrangement will be respected and never used outside the scope of the project;
All patient identifiers will be removed from data to preserve and respect patient confidentiality in line with the Data Protection Act.
Potential implications for patients, healthcare professionals and decision makers.
Data ownership
All data generated by the project will be owned by DRM-F/IPACT
No data will be disclosed to any third party except on the explicit agreement of all parties;
Patient confidentiality will be maintained at all times.
Process of submission and approval
All project proposal must be uploaded onto the IPACT website. The IPACT business manager (BM) will check for new proposals on the website on a fortnightly basis and confirm receipt of the project proposal to the applicant.
The BM will ensure the project has met the administrative criteria for submission (see table 1). If that is not the case, the BM will contact the applicants and request modification of proposal (within 15 days). Once the proposal meets the criteria, the BM will alert all board members and send them a copy of the project plan to be reviewed to judge if it fits into the general aims of the iPACT strategic plan (within another 15 days). The BM will upload project onto the board section of the IPACT website. This allows the board to have track of the submission date. The board review should be made according to the criteria listed in table 2. The voting of the proposal will be on the agenda for the next face-to-face board meeting. All members must fill in the grid before the meeting and issue a final rank/opinion about the possibility of considering the activity for the coming year. 5 members must always constitute the board so that no tie is possible. The board needs to provide feedback to the candidate activity in 2 months.
Table 1: Administrative criteria for proposals submitted for funding with PID:
Criteria
Yes/No
Responsible team for project development and implementation documented, including any potential subcontractors.
Deliverables clearly defined.
Timelines outlined.
Table 2: Strategic and scientific criteria for proposals submitted for funding:
Criteria
Yes/No*
Points (1-5)
Does the activity meet any of the broad objectives of iPACT
Is the activity generalizable to a global audience?
Is the need for such a project well established?
Does the activity clearly contribute to improve patient care?
Are various countries involved?
If subcontracting has given proof of 3 budget submissions?
Deliverable is clear and attainable within the timeline indicated?
Is the project methodologically sound?
Is there enough information to indicate that payment is only made upon delivery of the final product? Or depending on the amount on clear deliverables?
Is the budget presented clearly justified by the amount of work or by the substantial contribution for raising patient care?
Is there enough information to indicate that payment is only made upon delivery of the final product? Or depending on the amount on clear deliverables?
* If no, define if it may be possible to seek further clarification on the proposal or if it immediately fails. In some situations the board may ask for amendments to the proposal to meet the strategic aims of IPACT.
1. Changes to project proposal after approval
Where deviations have been made to agreed project criteria and outputs, the member will reconvene to discuss validity of the project and determine whether payment for services is still valid.
2. Declaration of Interests
All declarations of interest must be declared within PID. If the project requires subcontracting to medical writers, statisticians etc, it is the responsibility of the project owner to ensure there are no conflict of interests. IPACT board will request additional information on interests in such cases.
3. Payment structure
A fixed hourly rate of hourly rate of 50 euros is provided for IPACT projects, however there may be exceptions e.g. for the development of training videos. Where it is felt that the rate may differ, this must be stated within the PID.
Within the project initiation document an estimated number of hours to complete the project will be required. Projects will be reviewed at each milestone (date pre agreed with IPACT board) to ensure alignment with the agreed PID and to provide remuneration. Where there are delays, the board must be informed within two weeks of agreed review milestone date. If projects are significantly delayed e.g. over one month, the board and project manager will meet to discuss barriers to completion, potential solutions or to exit project agreement where appropriate.
Note: Where additional resources are needed e.g. statistical analysis, medical writing the payment will be made directly by IPACT to the named individual.
4. Criteria for project remuneration
Below is an example of remuneration milestones for a scientific project. Where education modules or videos are being developed, milestones for remuneration will differ and this will be agreed by the board and project lead.
Milestone of scientific project
% Of total remuneration
Project approved
10%
Data collection
10%
Results
10%
Write up
10%
On publication/poster presentation/on website
60%
Upcoming Projects
If interested in contributing to any of the projects below please click the button under the project header.
To raise awareness of Arrhythmias and equip individuals to check their own pulse at home
To quantify the contribution of pharmacists, in the context of inter-professional collaboration, for the identification of new cases of arrhythmias and for atrial fibrillation, the appropriate institution of anticoagulant therapy
Partners:
AFA/AA
Project steps:
Invite country coordinators (Sept/18)
Recruit pharmacists in various countries (Oct/18)
Train them for pulse measurement (Nov/18)
Provide materials in respective language (Nov/18)
Run the campaign (3rd week of Nov/18 - November 19th - 25th)
Analyse results of awareness and referral (Dec/18)
Monitor diagnosis confirmation and re-analyse results 3 months later (Feb/19)
Deliverables:
Results of campaign on AFA and iPACT website
Abstract in Eur Heart Journal
Manuscript in journal indexed in pubmed with IF
Timelines:
Milestone 1: 31 December 2018
Milesone 2: 31 July 2019
Milestone 3: 31 August 2019
If you have any questions about this project please email at info@ipact.org and CC the following board member:
Filipa Alves da Costa - filipa.alvesdacosta@ipact.org
To develop a structured step by step guidance for pharmacists (although applicable to any HCP) in delivering pulse awareness campaigns in both primary and secondary care settings (e.g. pharmacies, physician offices, hospitals etc.). This guidance should also include the follow up activities to ensure early diagnosis and treatment of undiagnosed patients as well as optimize interprofessional collaboration between HCPs (pharmacists, physicians etc.).
Partners:
AFA/AA
Project steps:
Roundtable meeting during an international conference with pharmacists (and other stakeholders) with experience with the implementation of Pulse awareness programs.
During this roundtable meeting facilitators and barriers to implement pulse awareness campaigns are inventoried.
Based on the results of the round table a guidance document will be written which will be published in English and Spanish on the website of IPACT and also will be presented during international congresses.
Deliverables:
Guidance in English on the websites of IPACT and AA/AFA
Pilot of use of guidance in at least 3 English speaking countries and 2 additional languages
Report of steering group meeting
Report on Questionnaire on Guidance
Report AF Awareness week / AA / AFA joint report
Publication in a pubmed indexed journal with IF
Presentation of guidance on an international cardiology and/or pharmacist congress (e.g. ESC, FIP, ESCP) in 2019
Timelines:
First report (English) –28 April 2019
Translated reports (2 additional languages) – 31 July 2019
Manuscript published – 31 August 2019
If you have any questions about this project please email at info@ipact.org and CC the following board member:
To develop an audit tool on the quality of transfer of care (with respect to anticoagulation drugs) evaluating the provision of information from hospitals to community care.
This audit tool will be disseminated across member organizations of the EAHP and subsequently the results will be published in the European Journal of Hospital Pharmacy and presented at international congresses.
Partners:
EAHP
Project steps:
Creation of a project group (together with the EAHP) with representatives of 3 pilot countries
Literature review of evidence base to address what good looks like in relation to transfer of care for anticoagulation from secondary to primary care.
Development of a guidance document on the transition of care, based on existing guidelines and the input of an international expert group for AF patients
Development of a Hospital Audit Tool on “Quality of transfer of care in anticoagulation” for AF patients together with EAHP across Europe. The tool also provides reference to best practice materials such as checklists, educational materials for HCPs and patients and other information (ranging from iPACT, EAHP, ESC, AA/AFA etc.)
Development and implementation via EAHP website (similar to hospital self-assessment tool of EAHP)
Pilot in 5 countries (UK, France, Germany, Netherlands, Spain)
Analysis of the results in the pilot countries
Publication and dissemination of results
Improvement of Hospital Audit Tool
Translation to EU languages for wider implementation approved by steering group comprising of both iPACT and EAHP)
Formulation of recommendation to improve the implementation of better transfer of care according to the IPACT/EAHP guidance document
Once finalized, intention to roll out to wider member organizations globally
Deliverables:
Audit tool on the quality of transfer of care (with respect to anticoagulation drugs) in the indications of AF as long-term condition
Report of steering group meeting
Pilot in 3 EU countries (UK, France, Netherlands)
Publication in a pubmed indexed journal with IF
Publication of Quality Audit Tool on website of EAHP and iPACT website
Run of pilot on website about the quality of transfer of care with respect to anticoagulation drugs
Timelines:
Milestone 1: 31 March 2019
Milestone 2: 31 May 2019
Milestone 3: 31 Sept 2019
Milestone 4: 31 Dec 2019
If you have any questions about this project please email at info@ipact.org and CC the following board member:
There is growing literature on the availability o pharmacist-led services in Europe and in Canada or US (perhaps to a lower extent in other continents). However, these tend to focus on services in general, ie, not specifically targeted at a disease area and are generally more interested in describing the pharmacist’s role. We believe it could be of greater interest to take a citizens’ approach and describe which are the services available, regardless of the provider or the setting. This will be a useful tool for anyone interested in anti-thrombotic care.
Objectives:
To create a roadmap describing the generalist and specific services available in anti-thrombotic care amongst ipact members countries.
Deliverables:
An infograph will be made available in iPACT’s website and with partner organisations (AFA, FIP, ESCP. Etc).
A more detailed report may be created with selected case-studies of unique services existing only in one or a few countries. These will be highlighted as poles of good practice in that area and may ultimately be used to motivate others to expand their scope of practice.
Countries involved:
All having representation in iPACT
Constraints:
Participation rate. Various reminders will be sent to members to maximise participation rate.
Methodology:
A cross-sectional design will be used, where data collected pertains to the reality on countries answering a web-based survey in 2019. We will not collect data on services planned, or on services that have existed but were proven unsustainable. We will not collect information either on the rate of implementation of the survey, but simply aim to assess if the service is available, and if so, where it is provided (ie, ambulatory practice, hospital or aged care; or combination of the former) and by who (GP, pharmacist, nurse, other health care provider; or combination of the former).
Project plan:
Phase 1: send out the grid to ipact members and ask them to review and add (if necessary, do not go into too much detail/specifics). – send on the 15th April, responses within two weeks with a reminder at 7 days (22th April)
Phase 2: refinement/finalisation of the grid (in parallel develop the technical application of it) 2 weeks (7th May)
Phase 3: send out to ipact members to click all the ones that apply (one per country; n=25) Send on the 8th May, give 2 weeks for answers, reminder at day 5 (aim for 100%)
Phase 4: publish/put in the website and send it to potential interested parties (FIP, pharma, ESC) Graphical improvement (15 days) - send it by end of May
Phase 5: expand to countries beyond the 25 countries (evaluate in June)
Phase 6: republish
Company names for subcontracting:
Lampyon
Two additional ones to be sought
Conflict of interest:
None at this moment (no funding has been obtained).
