Interprofessional Journal of Health Sciences. Vol.16 No.2 , July - December 2018.

THE EFFECTS OF PHARMACIST’S COUNSELING ON WARFARIN-RELATED CLINICAL OUTCOMES IN PHARMACY’S AMBULATORY CARE
 

Preechaya Tajai, Jariyakul Warinruk , and Tawinun Sunkwan

Abstract

The objective of this study was to determine the effects of the pharmacist counseling on warfarin management to outpatients who visited McCormick hospital, Chiang Mai, Thailand. Comparison of pre- and post-counseling service conducted over a period of 5 months. The outcomes were international normalized ratio (INR) control (therapeutic efficacy), warfarin-related complications and adverse events (safety), patients’ knowledge and satisfaction regarding warfarin. The data were collected from 26 outpatients who were prescribed warfarin. There were 16 patients (64.0%) who received pre-counseling service had out-of-range INR. There were 14 patients (87.5%) had sub-therapeutic INR. The analysis of INR control within the therapeutic range was not statistically different between pre- and post-counseling services (p=0.062). Thromboembolic complications were found in 4 patients (15.4%) and bleeding complications were found in 3 patients (11.5%) during pre-counseling period. Interestingly, thromboembolic and bleeding complications were not detected after post-counseling services (0%). Before receiving counseling service, the most 3 incorrect answers on warfarin knowledge were the effect of a missing dose and its management, the benefit of INR monitoring and the possible adverse effects of sub-therapeutic INR. Patient’s knowledge on warfarin among participants significantly increased after receiving counseling services (p<0.001). In addition, all participated outpatients satisfied with pharmacist counseling services. Taken together, this study demonstrated that pharmacist’s counseling could improve warfarin-associated complications, warfarin knowledge and patient’s satisfaction in pharmacy’s ambulatory care.

Keywords: warfarin, pharmacists’ counseling, complications

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DOI: 10.14456/ijhs.2018.1