Picture this: A patient who is taking the blood-thinning medication Coumadin (warfarin sodium, Bristol-Myers Squibb) visits his community pharmacy to have his blood checked. The pharmacist makes sure his dosage is correct and that his blood isn't getting too thin or too thick.
This scenario, familiar in many hospitals, is being played out in a Coumadin clinic that was launched in June in a Kmart Pharmacy in Helena, Mont., as a pilot.
Josh Morris, Pharm.D., a former hospital pharmacist, operates the clinic with two other pharmacists. They have all been certified via an eight-week on-line course offered by the University of Illinois at Chicago.
Noting that it took a year to open the clinic, Morris said the pharmacy had to develop a protocol and get it approved by the state pharmacy board. Signing up physicians for collaborative practice agreement was challenging, he said. The agreement provides physicians with two options, he explained. One option is to allow the pharmacist to implement changes in the patient's dosing without the patient scheduling regular visits with their doctor. The second option is for the pharmacist to fax his recommendation to the doctor for review. The recommendation can then be faxed back with any changes to be implemented by the pharmacist.
Pharmacists considering launching a Coumadin clinic should also have an agreement with patients, added Morris. "The nonbinding agreement says that if you get into the clinic, we will schedule appointments. If you miss the appointments, we'll contact you. If anything comes about because the patient hasn't been coming to the clinic, the clinic is free of any liability," he said.
Yet another housekeeping detail is to register with the CLIA (Clinical Laboratory Improvement Amendments) program, Morris noted. "It is the main regulator of laboratories. The machine we're using is a CLIA-waived machine, so we had to get a waiver from the program. This machine allows us to do a finger sticking versus a blood draw," he said.
Pointing out that the clinic has serviced 55 patients, 26 of whom have become full-time patients, Morris said, "We're fighting to get reimbursement from third-party sources. We are working with Montana Medicaid, Blue Cross/Blue Shield of Montana, and New West Health Services-all locally based insurance companies."
Morris said studies have been conducted showing that pharmacists who run anticoagulation clinics are successful in reducing costs for insurance companies by preventing emergency visits to the hospital. "One study showed an average savings to third-party payers of $1,600 per year per patient," he said.
Although Morris would not disclose the fee charged to patients for his services, he said he believes it is affordable. In order to announce the clinic to patients, the pharmacy is relying on newspaper and radio ads, as well as word of mouth.
Emphasizing that contact with the state board of pharmacy, state inspector, and laboratory state board is crucial for a successful Coumadin clinic, Morris said, "They are looking at cleanliness and procedures to ensure patient safety. We are dealing with blood products, and they want to know what we do to properly dispose of blood products. They are also making sure that all of our procedures are in order and that we are not just doing tests without collaborative practice agreements and approval from the physicians."
During the first appointment at the clinic, patients receive about half an hour of intensive counseling, including information about Coumadin and a discussion of food and drug interactions. Thereafter, the appointments take about 10 minutes.