Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-02T22:23:30.258Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical outcomes and patient satisfaction of a pharmacist-managed, emergency department–based outpatient treatment program for venous thromboembolic disease

Published online by Cambridge University Press:  21 May 2015

Peter J. Zed  and
Lyne Filiatrault
Peter J. Zed*
Affiliation:
Department of Pharmacy and Pharmacotherapeutic Specialist — Emergency Medicine, Queen Elizabeth II Health Sciences Centre, and College of Pharmacy and Department of Emergency Medicine, Dalhousie University, Halifax, NS
Lyne Filiatrault
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, and Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, BC
*
Queen Elizabeth II Health Sciences Centre, Department of Pharmacy–Halifax Infirmary, Rm. 2417, 1796 Summer St., Halifax NS B3H 3A7; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

The purpose of this study was to evaluate the efficacy, safety and patient satisfaction outcomes of our pharmacist-managed, emergency department (ED)–based outpatient treatment program for venous thromboembolism (VTE) disease.

Methods:

We conducted a prospective cohort study of all patients who were enrolled in the Vancouver General Hospital (VGH) outpatient VTE treatment program over a 7-year period (1999–2006). Efficacy outcomes include recurrent VTE events at 3 and 6 months following discharge from the program. Safety evaluation included major and minor bleeding complications and the development of thrombocytopenia during the acute phase of therapy. Patient satisfaction was assessed using an 18-question patient satisfaction survey, which was mailed to all patients following discharge from the program.

Results:

Overall, 305 patients were included in the study. Of the 260 evaluable patients, 2 patients (0.8%, 95% confidence interval [CI] 0.2–2.7) experienced a recurrent VTE at 3 months and 5 patients (1.9%, 95% CI 0.8–4.4) had a recurrence at 6 months. One patient (0.3%, 95% CI 0.1–1.8) experienced a major bleeding complication. Seven patients (2.3%, 95% CI 1.1–4.7) experienced a minor bleeding complication and no patient developed thrombocytopenia. Overall, 96.1% were comfortable having their condition treated as an outpatient and 85.7% felt it was more convenient to return to hospital daily for medications and assessment than to be admitted to hospital. Finally, 96.9% of respondents were very satisfied or satisfied with the treatment they received in the outpatient program, and 96.1% would enroll again if future treatment was indicated.

Conclusion:

Our pharmacist-managed, ED-based outpatient treatment program for VTE disease is safe, effective and achieves a high level of patient satisfaction.

Résumé

RÉSUMÉObjectif:

Cette étude visait à évaluer l'efficacité, la sécurité et la satisfaction des patients de notre programme de soins ambulatoires pour la thromboembolie veineuse (TEV), programme géré par un pharmacien dans un service d'urgence.

Méthodes:

Nous avons réalisé une étude de cohorte prospective de tous les patients qui étaient inscrits au programme de prise en charge ambulatoire de la TEV à l'hôpital général de Vancouver sur une période de 7 ans (de 1999 à 2006). Les principales mesures de l'efficacité comprenaient des épisodes récurrents de TEV trois et six mois après la fin de leur participation au programme. La sécurité a été évaluée en fonction des épisodes d'hémorragie grave et de saignements mineurs ainsi que de la survenue d'une thrombopénie pendant la phase aiguë de traitement. Un sondage de 18 questions envoyé par la poste à tous les patients après la cessation de leur participation au programme a permis d'évaluer la satisfaction des patients.

Résultats:

Dans l'ensemble, 305 patients ont été inclus dans l'étude. Parmi les 260 patients évaluables, deux [0,8 %, intervalle de confiance (IC) à 95 %, 0,2 à 2,7] ont eu un épisode récurrent de TEV après trois mois, et cinq patients (1,9 %, IC à 95 %, 0,8 à 4,4) ont subi une récurrence à six mois. Un patient (0,3 %, IC à 95 %, 0,1 à 1,8) a eu une hémorragie grave. Chez sept patients (2,3 %, IC à 95 %, 1,1 à 4,7), des saignements mineurs sont survenus et aucun patient n'a développé de thrombopénie. Au total, 96,1 % ne voyaient pas d'inconvénients à être traités en externe, et 85,7 % des patients préféraient se rendre à l'hôpital quotidiennement pour l'administration de leurs médicaments et une évaluation plutôt que d'être hospitalisés. Enfin, 96,9 % des répondants étaient très satisfaits ou satisfaits du traitement reçu dans le cadre du programme de soins ambulatoires, et 96,1 % s'y inscriraient de nouveau si un traitement futur était indiqué.

Conclusion:

Notre programme de soins ambulatoires pour la TEV géré par un pharmacien dans un service d'urgence est sécuritaire, efficace et suscite un degré élevé de satisfaction des patients.

Keywords

deep vein thrombosispulmonary embolismanticoagulationoutpatientpharmacistemergency department
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 1 , January 2008 , pp. 10 - 17
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1. White, RH. The epidemiology of venous thromboembolism. Circulation 2003;107(Suppl):I4–8.Google Scholar
2. Silverstein, MD, Heit, JA, Mohr, DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998;158:585–93.Google Scholar
3. Hyers, TM, Hull, RD, Weg, JG. Antithrombotic therapy for venous thromboembolic disease. Chest 1995;108(4 suppl):335S–51S.Google Scholar
4. Weinman, EE, Salzman, EW. Deep-vein thrombosis. N Engl J Med 1994;331:1630–41.Google Scholar
5. Hirsh, J, Levine, MN. Low molecular weight heparin. Blood 1992;79:1–17.Google Scholar
6. Weitz, JI. Low-molecular-weight heparins. N Engl J Med 1997;337:688–98.Google Scholar
7. Koopman, MMW, Prandoni, P, Piovella, F, et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular weight heparin administered at home. N Engl J Med 1996;334:682–7.Google Scholar
8. Levine, M, Gent, M, Hirsch, J, et al. A comparison of low molecular weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 1996;334:677–81.Google Scholar
9. Boccalon, H, Elias, A, Chale, J, et al. Clinical outcomes and cost of hospital vs home treatment of proximal vein thrombosis with low-molecular-weight heparin. Arch Intern Med 2000;160:1769–73.Google Scholar
10. Dolovich, LR, Ginsberg, JS, Douketis, JD, et al. A meta-analysis comparing low-molecular-weight heparins with unfractionated heparin in the treatment of venous thromboembolism. Arch Intern Med 2000;160:181–8.Google Scholar
11. Boucher, M, Rodger, M, Johnson, JA, et al. Shifting form inpatient to outpatient treatment of deep vein thrombosis in a tertiary care center: a cost-minimization analysis. Pharmacotherapy 2003;23:301–9.Google Scholar
12. Segal, JB, Bolger, DT, Jenckes, MW, et al. Outpatient therapy with low molecular weight heparin for the treatment of venous thromboembolism: a review of efficacy, safety and costs. Am J Med 2003;115:298–308.Google Scholar
13. Wells, PS, Kovacs, MJ, Bormanis, J, et al. Expanding the eligibility for outpatient treatment of deep vein thrombosis and pulmonary embolism with low-molecular-weight heparin. Arch Intern Med 1998;158:1809–12.Google Scholar
14. Chiquette, E, Amato, MG, Bussey, HL. Comparison of an anticoagulation clinic with usual medical care. Arch Intern Med 1998; 158:1641–7.Google Scholar
15. Vinson, DR, Berman, DA. Outpatient treatment of deep vein thrombosis: a clinical care pathway managed by the emergency department. Ann Emerg Med 2001;37:251–8.Google Scholar
16. Dager, WE, King, JH, Branch, JM, et al. Tinzaparin in outpatients with pulmonary embolism and deep vein thrombosis. Ann Phar-macother 2005;39:1182–7.Google Scholar
17. Vinson, DR, Berman, DR, Patel, PB, et al. Outpatient management of deep venous thrombosis: 2 models of integrated care. Am J Manag Care 2006;12:405–10.Google Scholar
18. Innes, GD, Dillon, EC, Holmes, A. Low-molecular-weight heparin in the emergency department treatment of venous throm-boembolism. J Emerg Med 1997;15:563–6.Google Scholar
19. Kovacs, MJ, Anderson, D, Morrow, B, et al. Outpatient treatment of pulmonary embolism with dalteparin. Thromb Haemost 2000;83:209–11.Google Scholar
20. Leong, WA. Outpatient deep vein thrombosis treatment models. Pharmacotherapy 1998;18:170S–4S.Google Scholar
21. Willey, ML, Chagan, L, Sisca, TS, et al. A pharmacist-managed anticoagulation clinic: six-year assessment of patient outcomes. Am J Health Syst Pharm 2003;60:1033–7.Google Scholar
22. Gray, DR, Garabedian-Ruffalo, SM, Chretian, SD. Cost-justification of a pharmacist managed anticoagulation clinic. Ann Pharmacother 2007;41:496–501.Google Scholar
23. Poon, IO, Lal, L, Brown, EN, et al. The impact of pharmacist-managed oral anticoagulation therapy in older veterans. J Clin Pham Ther 2007;32:21–9.Google Scholar
24. Locke, C, Ravnan, SL, Patel, R, et al. Reduction in warfarin adverse events requiring patient hospitalization after implementation of a pharmacist-managed anticoagulation service. Pharmacotherapy 2005;25:685–9.Google Scholar
25. Witt, DM, Sadler, MA, Shanahan, RL, et al. Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest 2005;127:1515–22.Google Scholar
26. Buller, HR, Agnelli, G, Hull, RD, et al. Antithrombotic therapy for venous thromboembolic disease. The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004; 126(Suppl):401S–28S.Google Scholar
27. Hull, RD, Raskob, GE, Pineo, GF, et al. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. N Engl J Med 1992;326:975–82.Google Scholar
28. Harrison, L, McGinnis, J, Crowther, M, et al. Assessment of outpatient treatment of deep-vein thrombosis with low-molecular-weight heparin. Arch Intern Med 1998;158:2001–3.Google Scholar
29. Wells, PS, Anderson, DR, Rodger, MA, et al. A randomized trial comparing 2 low molecular weight heparins for the outpatient treatment of deep vein thrombosis and pulmonary embolism. Arch Intern Med 2005;165:733–8.Google Scholar