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CPC-048 Establishing the Role of the Pharmacist in an Inpatient Anticoagulation Management Service in Belgium
  1. A Vervacke1,
  2. S Lorent1,
  3. S Motte2
  1. 1Erasme University Hospital, Pharmacy, Bruxelles, Belgium
  2. 2Erasme University Hospital, Thrombosis Unit, Bruxelles, Belgium


Background The complexity of the management of vitamin K antagonist (VKA) treatment has led to the development in many countries of anticoagulant management services (AMS) which provide patient education and good family physician communication in a systematic and coordinated fashion. In Belgium, there is only limited experience in AMS.

Purpose To determine the impact of a pharmacist-provided anticoagulation management programme (AMP) aiming at improving patient education and communication with the family physician.

Materials and Methods This was a prospective cohort study including consecutive inpatients newly initiated on VKA in an urban teaching tertiary care hospital. Patients and general practitioners were interviewed by phone shortly after discharge by using a standardised questionnaire to evaluate the quality of patient education and the quality of discharge reports before (usual care) and after implementation of a pharmacist-provided AMP. The AMP provided structured patient education and a standardised discharge report for family physicians.

Results With usual care, 58% of 26 patients received some form of unstructured education. Analysis of 42 discharge reports showed that duration of treatment, target INR (International Normalized Ratio), in-hospital INR results, scheduling of the next INR measurement and VKA maintenance dose were specified in 7%, 14%, 28%, 52% and 62% of them, respectively. Seventy-nine percent of 33 family physicians received the discharge report and 35% of them judged that it was complete.

With the pharmacist-provided AMP, all patients received structured education. Eighty-nine percent of 75 family physicians received the standardised discharge report and 99% of them judged that it was complete.

Conclusions The implementation of the structured pharmacist-provided AMP improved patient education and family physician communication.


  1. M.F. Crader, and Co., Hospital Pharmacy 2010; Volume 45(8): 618–623.

  2. T.J. Bungard, and Co., Open Medicine 2009, Volume 3(1): 16–21

No conflict of interest.

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