Guthrie has transitioned from a decentralized to a centralized anticoagulation (Coumadin) management model. The program offers several options for patients, including in-person visits with point-of-care (POC) INR testing at four clinic locations, INR testing through a laboratory, or self-testing with follow-up via MyChart or phone call. The team consists of pharmacists, registered nurses (RNs), and pharmacy technicians, with some staff working onsite and others remotely. Pharmacy technicians and RNs follow established protocols and escalate out-of-protocol issues to a pharmacist. Patients are referred to the service by a provider, and pharmacists may escalate certain situations back to the referring provider when needed.

After-hours results are managed through a rotating pharmacist on-call pager system, which provides coverage for urgent issues during evenings, weekends, and holidays. The program also includes physician Medical Director oversight, led by a physician specializing in benign hematology.

In addition to managing all aspects of warfarin therapy including peri-procedural management, refills, patient education, and adherence support the team also monitors patients taking direct oral anticoagulants (DOACs) through a reporting process that identifies patients who may require intervention.

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St. Charles Health System

Jessica Petkovic, MHA

Administrative Director of Primary Care

japetkovic@stcharleshealthcare.org

St. Charles is currently exploring a centralized model for anticoagulation management. We are the only anticoagulation provider in Central Oregon and manage approximately 12,000 patient visits annually.

Our current model consists of two nurse practitioners, 3 RNs, and 2 LPNs staffing anticoagulation clinics across multiple locations throughout the region. With both nurse practitioners leaving, we have a unique opportunity to reassess our approach.

We are still in the planning stages, but one model we're considering is transitioning anticoagulation management to our Ambulatory Care Pharmacists, who are embedded within Primary Care.

There are several considerations we're still working on, including:

• Opportunities to transition appropriate patients to DOACs.
• Processes for after-hours escalation of critical results.
• Workflows for handing off patients from the PharmD to a virtual provider during operating hours when additional clinical support is needed.
• Financial sustainability, given the limited reimbursement for anticoagulation management services.

I'd be interested in hearing from organizations that have implemented a similar model. What has worked well, what challenges did you encounter, and what can be done differently.

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Aspirus Medical Group

Mark Randell
Vice President of Operations

Mark.Randell@aspirus.org

Our Anticoagulation management is currently decentralized. We would like to move to a centralized model with one leader responsible for this service. We would like to learn from others about this.