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Clinical outcomes and patient satisfaction of a pharmacist-managed, emergency department–based outpatient treatment program for venous thromboembolic disease

Published online by Cambridge University Press:  21 May 2015

Peter J. Zed  and
Lyne Filiatrault
Peter J. Zed*
Affiliation:
Department of Pharmacy and Pharmacotherapeutic Specialist — Emergency Medicine, Queen Elizabeth II Health Sciences Centre, and College of Pharmacy and Department of Emergency Medicine, Dalhousie University, Halifax, NS
Lyne Filiatrault
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, and Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, BC
*
Queen Elizabeth II Health Sciences Centre, Department of Pharmacy–Halifax Infirmary, Rm. 2417, 1796 Summer St., Halifax NS B3H 3A7; peter.zed@dal.ca

Abstract

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Objective:

The purpose of this study was to evaluate the efficacy, safety and patient satisfaction outcomes of our pharmacist-managed, emergency department (ED)–based outpatient treatment program for venous thromboembolism (VTE) disease.

Methods:

We conducted a prospective cohort study of all patients who were enrolled in the Vancouver General Hospital (VGH) outpatient VTE treatment program over a 7-year period (1999–2006). Efficacy outcomes include recurrent VTE events at 3 and 6 months following discharge from the program. Safety evaluation included major and minor bleeding complications and the development of thrombocytopenia during the acute phase of therapy. Patient satisfaction was assessed using an 18-question patient satisfaction survey, which was mailed to all patients following discharge from the program.

Results:

Overall, 305 patients were included in the study. Of the 260 evaluable patients, 2 patients (0.8%, 95% confidence interval [CI] 0.2–2.7) experienced a recurrent VTE at 3 months and 5 patients (1.9%, 95% CI 0.8–4.4) had a recurrence at 6 months. One patient (0.3%, 95% CI 0.1–1.8) experienced a major bleeding complication. Seven patients (2.3%, 95% CI 1.1–4.7) experienced a minor bleeding complication and no patient developed thrombocytopenia. Overall, 96.1% were comfortable having their condition treated as an outpatient and 85.7% felt it was more convenient to return to hospital daily for medications and assessment than to be admitted to hospital. Finally, 96.9% of respondents were very satisfied or satisfied with the treatment they received in the outpatient program, and 96.1% would enroll again if future treatment was indicated.

Conclusion:

Our pharmacist-managed, ED-based outpatient treatment program for VTE disease is safe, effective and achieves a high level of patient satisfaction.

Résumé

RÉSUMÉObjectif:

Cette étude visait à évaluer l'efficacité, la sécurité et la satisfaction des patients de notre programme de soins ambulatoires pour la thromboembolie veineuse (TEV), programme géré par un pharmacien dans un service d'urgence.

Méthodes:

Nous avons réalisé une étude de cohorte prospective de tous les patients qui étaient inscrits au programme de prise en charge ambulatoire de la TEV à l'hôpital général de Vancouver sur une période de 7 ans (de 1999 à 2006). Les principales mesures de l'efficacité comprenaient des épisodes récurrents de TEV trois et six mois après la fin de leur participation au programme. La sécurité a été évaluée en fonction des épisodes d'hémorragie grave et de saignements mineurs ainsi que de la survenue d'une thrombopénie pendant la phase aiguë de traitement. Un sondage de 18 questions envoyé par la poste à tous les patients après la cessation de leur participation au programme a permis d'évaluer la satisfaction des patients.

Résultats:

Dans l'ensemble, 305 patients ont été inclus dans l'étude. Parmi les 260 patients évaluables, deux [0,8 %, intervalle de confiance (IC) à 95 %, 0,2 à 2,7] ont eu un épisode récurrent de TEV après trois mois, et cinq patients (1,9 %, IC à 95 %, 0,8 à 4,4) ont subi une récurrence à six mois. Un patient (0,3 %, IC à 95 %, 0,1 à 1,8) a eu une hémorragie grave. Chez sept patients (2,3 %, IC à 95 %, 1,1 à 4,7), des saignements mineurs sont survenus et aucun patient n'a développé de thrombopénie. Au total, 96,1 % ne voyaient pas d'inconvénients à être traités en externe, et 85,7 % des patients préféraient se rendre à l'hôpital quotidiennement pour l'administration de leurs médicaments et une évaluation plutôt que d'être hospitalisés. Enfin, 96,9 % des répondants étaient très satisfaits ou satisfaits du traitement reçu dans le cadre du programme de soins ambulatoires, et 96,1 % s'y inscriraient de nouveau si un traitement futur était indiqué.

Conclusion:

Notre programme de soins ambulatoires pour la TEV géré par un pharmacien dans un service d'urgence est sécuritaire, efficace et suscite un degré élevé de satisfaction des patients.

Keywords

deep vein thrombosispulmonary embolismanticoagulationoutpatientpharmacistemergency department
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 1 , January 2008 , pp. 10 - 17
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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