Evaluating the implementation of a rapid access atrial fibrillation clinic utilising a pharmacist-physician model of care

IF 3.7 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Research in Social & Administrative Pharmacy Pub Date : 2025-03-06 DOI:10.1016/j.sapharm.2025.03.005

Adam C. Livori , Rasantha Kuruppumullage , Mardi Simmons , Aili Langford , Zanfina Ademi , J. Simon Bell , Renee Dimond , Jedidiah I. Morton

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引用次数: 0

Abstract

Background

Time to assessment and treatment of atrial fibrillation (AF) is critical for reducing stroke risk. However, Australian data have shown low uptake of timely anticoagulation, with people in regional areas having a greater risk of low uptake compared to people in metropolitan areas.

Objective

To conduct a retrospective, mixed methods evaluation of a pharmacist-physician model of care for a rapid access atrial fibrillation (RAAF) clinic in a large regional centre in Victoria, Australia.

Methods

The RAAF clinic involved telehealth pharmacist appointments and face-to-face physician consults and aimed to see patients within 14 days of referral. A retrospective mixed-methods evaluation was adopted. Quantitative methods included time-based analysis of appointment statistics, analyses of the proportion of patients meeting known quality indicators for risk assessment and treatment for AF. Qualitative analysis included conventional content analysis of patient feedback and net promoter scoring to understand patient acceptability.

Results

There were 312 patients referred to the service during 2022–2023, 274 (88 %) patients participated in 268 pharmacist and 421 physician appointments. Median days from referral to first clinic consultation were 14 (inter quartile range 9–20). Proportion of high-risk patients (CHADSVA >1) who received anticoagulation for stroke prevention increased from 88 % pre-clinic to 97 % post-clinic. Anti-arrhythmic therapies were used by 76 % of patient's pre-clinic and 73 % post-clinic, with changes to therapy occurring in 35 % of patients. Patients were highly accepting of the service, with a mean patient acceptability score of 9 out of 10. Qualitative analysis illustrated that positive patient experience was linked to clinician performance, as well as the organisational structure and workflow of the clinic itself.

Conclusions

A pharmacist-physician model of care was successfully implemented in a regional health setting, leading to improved access and medication management, with high levels of patient acceptance.

查看原文本刊更多论文

评估利用药剂师-医生护理模式的快速访问房颤诊所的实施。

背景：评估和治疗心房颤动（AF）的时间是降低卒中风险的关键。然而，澳大利亚的数据显示，及时抗凝治疗的使用率很低，与大城市的人相比，偏远地区的人服用抗凝治疗的风险更低。目的：在澳大利亚维多利亚州的一个大型区域中心，对快速进入房颤（RAAF）诊所的药剂师-医生护理模式进行回顾性、混合方法评估。方法：RAAF门诊采用远程药师预约和面对面医师会诊两种方式，目标是在转诊后14天内就诊。采用回顾性混合评价方法。定量方法包括基于时间的预约统计分析、符合已知AF风险评估和治疗质量指标的患者比例分析。定性分析包括常规的患者反馈内容分析和净启动子评分，以了解患者的接受程度。结果：在2022-2023年期间，共有312例患者转诊，其中274例（88%）患者参加了268名药剂师和421名医生的预约。从转诊到首次门诊会诊的中位天数为14天（四分位数间距9-20）。高危患者（CHADSVA bbb1）接受抗凝治疗预防卒中的比例从临床前的88%增加到临床后的97%。76%的患者在临床前和73%的患者在临床后使用抗心律失常治疗，35%的患者改变了治疗方法。患者对这项服务的接受度很高，平均患者接受度得分为9分（满分10分）。定性分析表明，积极的患者体验与临床医生的表现以及诊所本身的组织结构和工作流程有关。结论：在区域卫生机构中成功实施了药剂师-医生的护理模式，改善了可及性和药物管理，患者接受程度很高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Research in Social & Administrative Pharmacy PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

7.20

自引率

10.30%

发文量

225

审稿时长

47 days

期刊介绍： Research in Social and Administrative Pharmacy (RSAP) is a quarterly publication featuring original scientific reports and comprehensive review articles in the social and administrative pharmaceutical sciences. Topics of interest include outcomes evaluation of products, programs, or services; pharmacoepidemiology; medication adherence; direct-to-consumer advertising of prescription medications; disease state management; health systems reform; drug marketing; medication distribution systems such as e-prescribing; web-based pharmaceutical/medical services; drug commerce and re-importation; and health professions workforce issues.