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Proposing a Framework for International Normalized Ratio Testing and Anticoagulation Management in Community Pharmacies

Mifsud, Elena Marie MPharm (Melit); Azzopardi, Lilian M. PhD; Serracino-Inglott, Anthony PharmD

Point of Care: The Journal of Near-Patient Testing & Technology: December 2014 - Volume 13 - Issue 4 - p 125–127
doi: 10.1097/POC.0000000000000038
Original Articles

Point-of-care testing devices that measure international normalized ratio (INR) are adequate alternatives to laboratory INR testing system. The main aim of the study was to investigate the feasibility and acceptability of a community pharmacist–led anticoagulation management service. Fifty INR tests were performed using the CoaguChek XS testing device at a community pharmacy on the same day that the patients’ venous plasma INR was monitored at the outpatient clinic. The level of agreement between the 2 INR methods was analyzed using the Pearson correlation, the Bland-Altman plot, and level of clinical accuracy. The patient’s perceptions about the current and proposed INR testing system were analyzed. All 50 patients had an overall good perception of the proposed framework, with 41 of the 50 patients interested to start using the service, if the framework is implemented. In addition, 29 of the patients would accept that the pharmacist performs warfarin dose adjustments. Linear regression analysis demonstrated a significant positive correlation between the 2 INR testing methods, thus demonstrating the reliability of point-of-care testing. This was further confirmed by the Bland-Altman plot and clinical agreement. These results encouraged the development of referenced guidelines for the decentralization of INR testing to community pharmacies. The study shows that the introduction of a national community pharmacist–led anticoagulation monitoring will improve the current anticoagulation management by reducing the provision of fragmented care and by improving INR testing accessibility, patient satisfaction, clinical reliability, and effectiveness.

From the Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.

Reprints: Elena Marie Mifsud, MPharm (Melit), 39, Tarsus, Triq it-Torri ital-Kaptan, Naxxar, NXR2154, Malta, Europe. E-mail:

The authors declare no conflict of interest.

Supported by the University of Malta Research Grant–Point-of-Care Testing.

© 2014 by Lippincott Williams & Wilkins