Effect of pharmacist intervention based on PDCA mode on atrial fibrillation patients treated with warfarin

Li Zheng; Qin Kan

doi:10.3760/j.issn.1673-4777.2019.09.008

Abstract：Objective To investigate the effect of clinical pharmacological intervention based on PDCA mode on anticoagulant therapy in patients with atrial fibrillation.Methods From January 2017 to March 2018,106 patients with atrial fibrillation who took warfarin in the Third Affiliated Hospital of Anhui Medical University were randomly divided into observation group and control group,with 53 cases in each group.The control group had warfarin anticoagulation guided by doctors and nurses.In observation group,clinical pharmacists participated in the implementation of anticoagulant therapy;individualized pharmaceutical care was applied according to PDCA mode.Coagulation indexes,Morisky score and anticoagulant adverse events were analyzed during 6 months of treatment.Results Before admission,international normalized ratio(INR),time in therapeutic range(2.0-3.0)(TTR),rate of TTR≥58％ showed no significant differences between groups(all P ＞ 0.05).Six months after treatment,INR,TTR,rate of TTR ≥ 58％ showed no significant changes in control group (all P ＞ 0.05).In observation group,INR,TTR and rate of TTR ≥ 58％ after treatment were significantly higher than those before admission and those in control group [(2.2 ± 0.3) vs (1.8 ± 0.4),(2.0 ± 0.4);(61 ± 15) ％ vs (40 ± 19) ％,(45 ± 15) ％;69.8％ (37/53) vs 32.1％ (17/53),45.3％ (24/53)] (all P ＜ 0.05).There was no significant difference of Morisky score between groups before admission(P ＞ 0.05).Six months after treatment,Morisky score significantly increased in both groups and it was higher in observation group than that in control group [(7.1 ± 0.7) vs (6.3 ± 1.0)] (P ＜ 0.05).During treatment,the total incidence of anticoagulant adverse events in observation group was significantly lower than in control group[20.8％ (11/53) vs 39.6％ (21/53)] (P =0.029).Conclusion Patient-centered pharmacist intervention based on PDCA mode can effectively improve the effectiveness of anticoagulant therapy,improve patients compliance and reduce adverse events in the management of atrial fibrillation.