PB1369 - Challenges of Anticoagulation Management Service and Need of Establishing Pharmacist-Led Anticoagulation Clinic in Tertiary Care Teaching Hospital, Ethiopia: A Qualitative Study

Background: The complexity of anticoagulation management has led to the advancement of a variety of care models comprising patient self-management, anticoagulation clinics, and pharmacist-managed services in many countries.

Aims: To explore the challenges of AMS, and assess the need for establishing pharmacist-led anticoagulation clinic (PLAC) at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia

Methods: A qualitative study was conducted at TASH. A semi-structured interview guide was used by interviewing 15 physicians from different specialties, heads of pharmacy and laboratory departments, and 20 patients to explore their overall ideas, perception, experience about AMS and the challenges of AMS, and the need of establishing PLAC in the hospital.

Results: Only 3 physicians responded they had warfarin initiation and maintenance dosing protocols. Out of 15 respondents, three, seven, six, and four of them stated that they had protocols for venous thromboembolism (VTE) risk assessment; VTE prophylaxis and treatment; and bleeding risk assessment, respectively. Out of the total, 80% of respondents stated that inadequately trained healthcare professionals (HCPs), absence of separate anticoagulation clinic for anticoagulation management and patient education, irregular availability of anticoagulants and INR testing, and long appointment time, were the main challenges of existing AMS. All patients mentioned they have bought the anticoagulant and tested their INR out of the hospital on more than one occasion. Fourteen (70%) described that there was a long waiting time that affects their satisfaction towards the AMS provided to them. The interviewees suggested that it is necessary to establish PLAC with the well-adopted standard operating procedure (SOP), skilled manpower, sufficient training for assigned staff, and sustainable supply of anticoagulants and INR testing.

Conclusion(s): There were many limitations in the anticoagulation management service of the studied hospital. Based on these recommendations and literature consultation and experience elsewhere PLAC was established in TASH.