The Effects of Pharmaceutical Care Model Development at Warfarin Clinic in 30-Bed Community Hospital
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Abstract
Anticoagulant drug, Warfarin, had many indications in Thailand but it has limited pharmacodynamic and pharmacokinetic. Because of a narrow therapeutic index and different response in individual person, overdose could cause severe bleeding while underdose could cause ineffective in treatment. Thus, a proactive pharmaceutical care model may improve effectiveness and manage drug related problems. Material and method: A retrospective study was conducted in Luangphopern Hospital. Total 32 patients who treatment in warfarin clinic were divided into 2 groups; a preintervention group had 16 patients during 1 January-31 December 2017 and a postintervention group had 29 patients who received improved pharmaceutical care during 1 January-31 December 2019. Data was collected from electronic medical record and pharmaceutical care record in warfarin clinic, Then analyzed to mean percentage of time in therapeutic range (TTR) and the percentage number of patients who had TTR more than 60% by T-test and chi–Square, respectively. Results: The patients were recruited with 16 patients control group and 29 patients treatment group. There was no significant different in characteristics of gender, age, and indication. However, time to follow up INR was statistically significant difference (P<0.001). The results showed that mean percentage of TTR in intervention group were improved from 49.30 ± 26.32 to 66.49 ± 25.71 (P=0.039) and the percentage of patients with TTR more than 60% were from 35.70 to 68.97 (P=0.041). When compared to control group. The most drug related problems were inappropriate behavior by patient. Conclusion: The development proactive of pharmaceutical care model in 30 beds community hospital can improve the TTR within target via finding the problem, processing the problem management and follow up for resolving. This model increases the efficiency and safety of warfarin treatment.
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