Pharmacy Anti-coagulation Management Services (AMS) - FAQs

What is the pharmacy AMS project?

Health Workforce New Zealand (HWNZ) is to fund up to 15 demonstration sites where community pharmacies will provide anticoagulation therapy (warfarin) to local patients in collaboration with general practices.

The project was proposed by the Pharmaceutical Society of New Zealand after a successful trial in a Hamilton pharmacy.

The pharmacist role in the demonstration sites will be extended from dispensing and offering advice on the basis of an existing prescription for warfarin to being able to initiate or modify a prescription in collaboration with the GP.

Some pharmacists in the United States, Canada, Australia and the UK have already taken on this role, particularly in secondary care.

The aim of the community pharmacy AMS is to provide safe, effective and cost-effective care that is acceptable to patients and other health professionals.

Why are we trialling this way of managing medication?

Warfarin is a widely prescribed drug-thinning drug, particularly among older people where it is successfully used for stroke prevention. However, research indicates that it is under-utilised and is not always well-managed. The project aims to benefit patients both in management of their health and in single point of care access.

Pharmacists have extensive training and knowledge of medicines management and professional bodies, employers, the MoH and HWNZ are looking at how to make best use of those skills.

Having certain medicines managed in pharmacy settings should mean fewer general practice visits, offering more convenience for patients and freeing up valuable GP and practice nurse time.

Which pharmacies will be able to prescribe warfarin?

Demonstration sites will be chosen to ensure the model is tested in a variety of diverse settings, including urban and rural areas and high need populations.

Pharmacists will need to fulfil certain criteria in order to be selected, including having a local general practice to partner in the project and undergoing specific training and assessment.

If evaluation indicates that the project has been successful across the 15 demonstration sites, it is hoped it will be rolled out to other pharmacies that meet the criteria.

Which patients will have their warfarin medication managed by their pharmacist?

Patients will be identified and enrolled in the programme with the pharmacy through their GP. To be eligible to participate, patients must agree and meet certain criteria

How will it work in practice?

Prescribing protocols will be put in place with the general practice working in a collaborative model with the accredited pharmacy. The GP will sign standing orders for patients in their practice and will designate which pharmacists the standing orders apply to.

Patients will go to their enrolled pharmacy for their finger-prick blood testing using the Roche point-of-care test system. A predictive software programme designed specifically for warfarin management will be used for dose recommendations and for working out when the next test should be taken.

The patient will be able to see their INR result and discuss how they are doing with the pharmacist.

How will it be monitored?

An independent evaluation will be carried out to confirm the preliminary cost-benefit analysis, safety and efficacy of the model, and assess the impact on the various professional groups.

The project will be overseen by a steering group, which includes Dr Paul Harper,(MidCentral DHB) Professor Les Toop (University Otago) and Professor John Shaw (University Auckland) and Elizabeth Plant, President of the Pharmaceutical Society of NZ.

When will it start?

Sites are to be established from November, following the agreement of a contract between HWNZ and the Pharmaceutical Society and evaluation will be completed by September 2011.

Will there be more pharmacist management of medications in the future?

If successful, the project could pave the way for similar initiatives that better utilise community pharmacist skills in patient care, particularly in dosage management and support for medicine compliance in stable patients with long term health conditions.