Outcomes of Pharmaceutical Care in Patients Receiving Warfarin during Admission in a Community Hospital
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Abstract
Objective: To study the outcomes of pharmaceutical care by pharmacists in resolving warfarin related problems (WRPs) during patient stay in a community hospital. Method: This research was a descriptive study that prospectively collected the data on WRPs in all 104 patients admitted to the inpatient unit of Lat Yao Hospital in Nakhonsawan during November 2015 to November 2016. Results: 75.96% of patients received most recent warfarin therapy from community hospitals. 71.15% of patients were given warfarin to treat atrial fibrillation without valvular diseases (nonvalvular atrial fibrillation). The cause of 77.83% of hospitalizations was due to other causes unrelated to warfarin and 22.12% were from WRPs. The INR was performed in 72.12% of patients at the first day of admission. The INR levels in 20 patients (28.98%) were within treatment goal of 2-3, while INR of one patient (16.67%) was within treatment goal of 2.5-3.5. The study found no order of INR test on the first day of hospitalization in 20.19% of subjects, and in 7.69% of patients (who just started warfarin therapy with prothrombin time>180 seconds). On the day of discharge, INR test was performed in 61.54% of patients. Among them, INR of 29 patients (50%) was in target value of 2-3 and no patients with INR in treatment goal of 2.5-3.5 were found. The study identified 188 WRPs, 174 of which (92.55%) were resolved by pharmacists. Three most common problems were no monitoring of treatment efficacy or no physician order for INR test (72 problems with 65 or 90.28% resolved by pharmacists), drug interactions (62 problems with 58 or 93.55% resolved by pharmacists) and adverse drug reactions (21 problems with 20 or 95.24% resolved by pharmacists. On the first day of hospitalization, the INR in 28% of patients was in therapeutic ranges (in both levels of treatment goals). On the day of discharge, patients with INR in therapeutic ranges increased to 45.31%. Conclusion: Pharmaceutical care in patients receiving warfarin during hospitalization increased the proportion of patients with INR within the target range on the discharge day, and resolved WRPs effectively. The study implies that pharmacists have the potential to take care for patients and can work seamlessly with the multidisciplinary team to provide patients with the most appropriate and individualized medication.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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