ASHP Best Practices Award Mortar and Pestle

Award Information

Implementation and Outcomes of a Pharmacist Managed Clinical Video Telehealth Anticoagulation Clinic

Lakshmi G. Singh, Pharm.D., BCACP, Karen Korch Black, Pharm.D., CGP, BCACP, Mallory Accursi, Pharm.D., Meera R. Embran, Pharm.D., BCACP, Nnenna L. Iheagwara, Pharm.D., BCPS, Courtney T. Becker-Howell, MHSA, Carol B. Rudo, Pharm.D., BCPS


Veterans Affairs Maryland Health Care System (VAMHCS), Baltimore, Maryland

The Fort Howard (FH) community based outpatient clinic (CBOC) serves a small Veteran population in a geographic area with limited access to health care. In fiscal year 2012, 145 patients were seen at the FH CBOC anticoagulation (AC) clinic versus 922 patients at the primary medical center clinic. Ambulatory care clinical pharmacy specialists rotated 3 days per week to the CBOC providing face-to-face visits. Increasing demands for clinical pharmacy specialists at the medical center with no resources to hire additional staff led to the pursuit of telehealth services as a means to provide AC services. This program’s purpose was to optimize utilization of the ambulatory care clinical pharmacy staff at the medical center while continuing to provide quality AC services at the CBOC by using Clinical Video Telehealth (CVT) technology.

CVT uses real-time video conferencing to provide care to patients remotely and replicates face-to-face visits. CVT involves two separate stations at the patient and provider sites. A global media cart is set up at the patient site which consists of two HD widescreen and touch screen monitors, as well as a variety of devices for physical assessments. The station at the provider site has a HD monitor that displays the patient end.

Prior to implementation, policies and procedures for the clinic were developed by pharmacy service, telehealth staff, and CBOC nursing staff. Based on workload, it was determined that 3 half-days would be necessary to maintain adequate access to AC services. In June 2012, the CVT AC clinic was implemented. Adjustments were made to improve efficiency by certifying the telehealth technician on the point-of-care machine used to obtain international normalized ratios (INRs). An Institutional Review Board approved research study was conducted to examine the effects of the pharmacist managed CVT AC clinic on clinical outcomes and patient satisfaction. Of the 151 patients screened, 38 met inclusion criteria. INRs collected 6 months pre and post implementation were used to evaluate time in therapeutic range (TTR). A previously approved survey was utilized to evaluate patient satisfaction. There was no significant change in mean TTR pre and post implementation, 76.4% vs. 80.8% respectively (p=0.62). The mean survey score was 4.77 out of 5 with a mean total score of 56.98 out of 60.

The Pharmacist Managed CVT AC Clinic used innovative technology to improve the utilization and efficiency of the  ambulatory care clinical pharmacy staff while continuing to provide high quality care and maintaining patient satisfaction. This model can be implemented in a variety of health care settings to deliver pharmaceutical care. With use of CVT, pharmaceutical care opportunities can expand beyond the confines of where the clinical pharmacy specialist is physically located.

View a pdf of the poster from the Midyear Meeting (259 KB)