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

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.