(1348) Implementation of Pharmacist-led VTE Follow-up Services After ED Visits at an Academic Medical Center

Objectives: Patients with new onset venous thromboembolism (VTE) are diagnosed and often prescribed anticoagulation therapy in the emergency department (ED). Patients may be lost to follow-up after their ED visit due to a variety of reasons such as misunderstanding of their disease state, lack of patient counseling, or financial barriers. IN 2020, PACKARD ET AL. HIGHLIGHTED A CORRELATION BETWEEN RECURRENT VTE EVENTS AND NON-ADHERENCE TO DIRECT ORAL ANTICOAGULANT (DOAC) THERAPY. THEIR FINDINGS SHOWED THAT NON-ADHERENT PATIENT GROUP WERE MORE LIKELY TO HAVE HAD A RECURRENT VTE DURING 1- TO 6- MONTH FOLLOW UP AND 1- TO 12- MONTH FOLLOW UP.
TO ADDRESS GAPS IN TRANSITIONS OF CARE, A STUDY BY DIRENZO ET AL. PROPOSED A PHARMACIST-LED VTE FOLLOW-UP UTILIZING STANDARDIZED PROTOCOLS UNDER A COLLABORATIVE PRACTICE AGREEMENT (CPA). THIS APPROACH WAS SUGGESTED TO BE AS SAFE AND EFFECTIVE AS CARE PROVIDED BY PRIMARY CARE PROVIDERS (PCP). ADDITIONALLY, IN 2020, KARAOUI ET AL. FOUND THAT WHILE PHARMACIST-LED VTE FOLLOW-UP DID NOT SIGNIFICANTLY REDUCE BLEEDING OR READMISSION RATES AT DAY 30, IT NOTABLY IMPROVED PATIENT COMMUNICATION WITH PROVIDERS IN THE EARLY POST-DISCHARGE PRIOD. IT IS CRUCIAL TO NOTE THAT MOST STUDIES FOCUSED EXCLUSIVELY ON DOAC PRESCRIPTIONS, OVERLOOKING THE INCLUSION OF PATIENTS ON WARFARIN AND ENOXAPARIN. GIVEN THE CLOSE MONITORING REQUIRED FOR WARFARIN AND THE POTENTIAL NEED FOR COUNSELING ON ENOXAPARIN ADMINISTRATION, THE INCLUSION OF THESE PATIENTS BECOMES IMPERATIVE.
This creates an opportunity to expand pharmacy services to promote patient safety by ENSURING appropriate dosing, increasing medication adherence, access to care, and reducing the PCP workload. THEREFORE, THIS STUDY IS TO BE IPLEMENTED WITH THE PURPOSE OF CREATING A PHARMACIST-LED VTE FOLLOW-UP RPOCESS AFTER AN ED VISIT AT UNIVERSITY OF MISSOURI HEALTH CARE AND ASSESSING ITS EFFECTIVENESS IN CLOSING THE GAPS IN CARE.

Methods: This is a single center, prospective study that will be conducted from 8/1/2023 to 1/1/2024 at University of Missouri Health Care (MUHC). Pharmacists in the Anticoagulation Clinic will identify patients who were prescribed a new anticoagulant therapy (apixaban, rivaroxaban, edoxaban, dabigatran, enoxaparin and warfarin) from the ED. The pharmacist will evaluate the appropriateness of the prescription through a chart review and make an intervention if necessary. The pharmacist will provide education and counseling, identify barriers to taking the new prescription and provide financial assistance if needed.
PRIMARY ENDPOINTS OF THE STUDY ARE THE NUMBER OF SUCCESSFUL INITIAL INTERVENTIONS AND THE NUMBER OF SUCCESSFUL FOLLOW-UP INTERVENTIONS. THE NUMBER OF SUCCESSFUL INITIAL INTERVENTIONS IS MEASURED BY COLLECTING DATA ON IF THE PATIENT RECEIVED THE PRESCRIBED ANTICOAGULANT WITH AFFORDABLE COPAY AND RECEIVED MEDICATION COUNSELING FROM A PHARMACIST. THE NUMBER OF SUCCESSFUL FOLLOW-UP INTERVENTIONS IS MEASURED BY CONFIRMING THAT THE PATIENT RECEIVED A REFILL OF THE PRESCRIBED ANTICOAGULANT WITHOUT ANY COST BARRIERS.
SECONDARY ENDPOINTS WILL BE EVALUATED TO SPECIFY IF THERE ARE OTHER FACTORS THAT IMPACT THE PHARMACIST’S WORKFLOW AND PATIENT OUTCOMES. THE SECONDARY ENDPOINTS COLLECTED DURING THE STUDY INCLUDE TIME FROM ED DISCHARGE TO INITIAL PHARMACIST FOLLOW-UP CALL, TYPE OF INSURANCE, TYPES OF INTERVENTIONS (I.E., ASSESSING APPROPRIATENESS OF DOSING, CATCHING SIGNIFICANT DRUG INTERACTIONS THAT CAN DECREASE ANTICOAGULANT EFFICACY OR INCREASE BLEEDING), PATIENT HISTORY OF TAKING ANTICOAGULANTS, AND 30-DAY ED/HOSPITAL READMISSION RATES.
THE PROTOCOL WAS REVIEWED BY THE UNIVERSITY OF MISSOURI IRB AND WAS EXEMPTED FROM IRB REQUIREMENTS.

Results: N/A

Conclusions: N/A