DOAC screening service reduces dosing errors, improves medication access

Implementing a direct oral anticoagulation (DOAC) screening service at a large academic medical centre provides patient education and results in improved medication access, improved follow-up, and the identification and resolution of dosing errors, according to a study.

A pharmacist-led antithrombosis clinic started a clinical service to provide oversight for all prescribed DOACs. This was done by using a daily electronic prescribing report of DOAC prescriptions. Clinical pharmacists then reviewed prescriptions to assess patient insurance, eligibility and accuracy of prescribed doses.

In total, 317 new prescriptions and 595 refill prescriptions were reviewed in the first year since service implementation in April 2016. A DOAC service pharmacist contacted 125 (39.4 percent) of 317 patients regarding their new prescription and 59 (9.9 percent) of 595 refill patients to provide education and follow-up on management as needed. Seventy-nine (28 percent) new prescriptions and 86 (14.5 percent) refill prescriptions received interventions.

For the new prescriptions, common interventions performed were contacting the prescriber for a medication or dose change (25.4 percent), assistance with medication access (21.5 percent), and coordinating appropriate lab and provider follow-up (21.5 percent). Common interventions with refill prescriptions included recommending appropriate follow-up (50 percent) and contacting the prescriber for medication or dosage change (24.4 percent).

These findings were consistent with those of a 2017 study which reported that a pharmacist-led DOAC service increased appropriate dosing of DOACs at baseline and follow-up as well as patient adherence to therapy. [Am J Health Syst Pharm 2017;74:483-489]