A Comparison Of Pharmacist Managed Anticoagulation Therapy To Non-Pharmacist Managed Therapy: A Meta-analysis

Abstract

OBJECTIVES: To compare the INR-based results of pharmacist anticoagulation management services to non-pharmacist managed anticoagulation therapy. METHODS: A meta-analysis was performed using studies that reported on pharmacists’ services and interventions in anticoagulation. Two reviewers independently assessed each record retrieved by the literature search, and studies were eliminated if both reviewers agreed that the study did not meet the inclusion criteria. The analysis found eight studies that were eligible for inclusion. The primary independent variable was the presence or absence of pharmacist services. The primary dependent variables were the proportion of patients within INR range, the duration of time within that range, and the time required to achieve that range. Extracted data were pooled and entered into the meta-analysis, and a forest plot was constructed. The a-priori alpha level was 0.05. RESULTS: The eight studies were divided into two groups: The INR group consisted of four studies which used INR test data points as the unit of analysis. The Patient group included four studies which measured the patient’s INR only at the end of the study. The INR group demonstrated a significant difference favoring pharmacist services, with a p-value of 0.02 for the group. There was no significant difference between pharmacist services and the control group with respect to the Patient group. When all eight studies were pooled together, the overall forest plot did demonstrate significant favorability for pharmacist services, with an odds ratio of 1.58, indicating that pharmacist provided services improved care by 58% (Z = 2.8;p p = 0.01). CONCLUSIONS: The advantage of a pharmacist service in reaching goal INR was significant compared to the control group of non- pharmacist care.