Background:Diabetes and hypertension have been identified as risk factors for HCV complications in previous studies.This has sparked the interest in the field of prevention by identifying at-risk individuals and incre...Background:Diabetes and hypertension have been identified as risk factors for HCV complications in previous studies.This has sparked the interest in the field of prevention by identifying at-risk individuals and increasing investments for screening among pharmacists.The aim of this study was to screen for risk factors,including age,gender,BMI,hypertension,diabetes,and obesity,in Egyptian patients with HCV Methods:A prospective cross-sectional study was carried out from September 2018 to February 2019,with a total of 1,959 medical records collected.By comparing the patients'characteristics,variables related to metabolic risk,and body composition measurements,regression models have been established to determine any confounding factors.Results:The prevalence of HCV antibody was 41.0%in men and 59.0%in women.Among the variables included in the regression analysis,age,BMI,and uncontrolled hypertension were found to have statistically significant associations with diabetes in HCV positive cases(p<0.001).HCV patients>40 years old with high BMI were found to have significant associations with both,diabetes and hypertension(p<0.001).Hypertensive HCV patients were found to have significant associations with gender,age>40,and DM(p<0.001).Conclusion:HCV infection and metabolic disorders have a closed cycle relationship.Reducing the complications of DM has a promising prospective of limiting the complications of HCV .展开更多
Alzheimer’s disease (AD) is a neurodegenerative disorder that is characterized by progressive loss of memory, confusion, inability of speech and decline in the cognitive behavior. It is considered one of the most com...Alzheimer’s disease (AD) is a neurodegenerative disorder that is characterized by progressive loss of memory, confusion, inability of speech and decline in the cognitive behavior. It is considered one of the most common forms of dementia. Clinical studies and preclinical data in the last decade proved that AD and Diabetes mellitus share a pathophysiological pathway, indicating that insulin resistance, oxidative stress and inflammatory response would increase the risks of developing AD in diabetic patients. This review presents briefly the etiology of AD and Diabetes, discusses the possible theories about the interplaying risk factors and the mechanism of action of anti-diabetic medications recommended for the treatment of AD. It is concluded that antidiabetics have good potential to improve dementia, especially in earlier AD stages. However, many of the underlying intricate molecular pathways are still unclear and thus thorough future research is required.展开更多
Objectives: The objective of this study was to evaluate the knowledge and perceptions of patients towards generic medicines in some Emirates of the United Arab Emirates. Methods: A cross-sectional survey involving pat...Objectives: The objective of this study was to evaluate the knowledge and perceptions of patients towards generic medicines in some Emirates of the United Arab Emirates. Methods: A cross-sectional survey involving patients in three Emirates was undertaken. A 23-item questionnaire was designed, pre-validated and administered. Results: The questionnaire was fully answered by 96 patients out of 120 producing a response rate of 80%. The majority of patients were young Arab females with a university degree. Slightly less than 50% of patients were having a monthly income of less than ED 10,000. Results of the patient’s survey indicate that they have poor knowledge and perception of generic medicines. They did not know the meaning of generic or brand medicines and this negatively influenced their responses to consequent questions. Conclusion: Patients’ knowledge and perception of generic drugs were poor. Efforts are needed to increase public awareness of generic drugs and possible brand substitution. Both the prescribing physician and the dispensing pharmacists have an essential role to play in educating their patients of generic drugs.展开更多
The present study aims to investigate the perceptions and experience of physicians regarding the clinical role of the pharmacists. This is an observational study that was conducted during the period of September 2013 ...The present study aims to investigate the perceptions and experience of physicians regarding the clinical role of the pharmacists. This is an observational study that was conducted during the period of September 2013 through March 2014. A self-administered questionnaire was designed to be distributed by personal interview to the physicians. The questionnaire population consisted of randomly selected physicians practicing in UAE. The questionnaire was piloted by 10 physicians for face and understandability. Demographic data, frequencies and cross tabulation between different variables were calculated. The Chi-square test was used to determine the significance of association between categorical variables (gender, length of medical practice, and specialty) and the perception of physicians. A total of 285 filled questionnaires were returned representing 285 physicians, with a male dominance (65.3%). The average age of the physician screened was 32.4 (SD = 10.38) years with a minimum one year experience and up to 24 years. General practitioners consumed the widest sector (21.8%) followed by cardiologists (15.8%), then internal medicine (10.1%). In the current study, two thirds of the physicians believed that pharmacists could act as a reliable source of general drug information and play an important role in discovering clinical related problems. It was found that the physicians who had fewer years in practice (less than 10 years) and recently graduated had more acceptances to the clinical role of the pharmacist and believed that there should be a clinical pharmacy services in their hospitals (p-value < 0.05). No other statistically significant differences were found from analyzing the data. In conclusion, results suggest that physicians in UAE appear comfortable with pharmacists providing the broad range of services but appear somewhat less comfortable with pharmacists’ provision of direct patient care.展开更多
Patient care in a community is becoming critical due to change in the impact of diseases on health. The provision of pharmaceutical care in a community will bring in positive changes in health care delivery. However, ...Patient care in a community is becoming critical due to change in the impact of diseases on health. The provision of pharmaceutical care in a community will bring in positive changes in health care delivery. However, the pharmacist in developing countries has remained obscure in direct health- care of the patient. The main aim of this article is to reinforce the concept that there is a need to strengthen the basic pharmaceutical system in the Arab and African world before implementing any advanced clinical pharmacy or pharmaceutical care services to our communities. This article gives a good insight of where pharmacy practice in Arab, African and other developing countries globally stand in comparison to developed nations. A trend is apparent towards increased emphasis on clinical pharmacy practice. Country-specific pharmacy education and practice are discussed, analyzing the progress and opportunities available to pharmacy graduates. In addition, the future of pharmacy practice and clinical roles of hospital and community pharmacists were reviewed. It was realized that pharmacy practice and progress in many of the Arab and African countries were a mirror image of the status of the country itself. A new vision for the future of pharmacy practice needs to be considered and reorientation of pharmacy services in the existing system is needed. There should be a professional approach to speed up the rise towards practicing clinical pharmacy and pharmaceutical profession. This is achieved by interviewing patients, documenting their health details and educating them on methods of improving their health, including proper medication usage and lifestyle modification. Furthermore, colleges of pharmacy need to revise and update their curricula to accommodate the progressively increasing development in the pharmaceutical education and the evolving new roles of practicing pharmacists in their community.展开更多
Background: Proton pump inhibitors (PPIs) are drugs that reduce the production of acid in the stomach. Recently, the use of PPI has been increasing among communities, whether with or without prescription. As a part of...Background: Proton pump inhibitors (PPIs) are drugs that reduce the production of acid in the stomach. Recently, the use of PPI has been increasing among communities, whether with or without prescription. As a part of the healthcare team, the pharmacist should not only dispense medications but also ensure the appropriate use of these medications. Studies conducted within 16 countries showed substantial variation in the appropriateness of the use of PPI drugs. Aim: To evaluate the appropriateness of PPIs use in Sharjah, UAE based on surveys answered by pharmacists, physicians, and patients. Methods: A cross-sectional survey study was conducted on December 2017 at Sharjah, UAE as an example of information obtained from the Middle East. Two different surveys were conducted on physicians and pharmacists. Both Physicians and Pharmacists were chosen randomly from Yellow Pages. The results obtained from both studies were used to develop a patient’s survey, which was distributed among University of Sharjah students, their families and random people at Shopping Malls and Clinics. Results: The results obtained from the patients’ survey showed that ~39% of PPI users from the region of Sharjah are 25 - 44 years old. Approximately 79% are using PPI according to physicians’ prescriptions. Prescriptions’ duration is varied between 1 month (39%) and 6 months (22%), where 52% of PPI users ask their physicians to prescribe PPIs when needed. Suggested reasons for the use of PPI included inappropriate food habits (52%), use of other medications (16%) or bacterial infection (13%). Around 52% of the patients did not receive any recommendations regarding the deprescribing of PPIs. According to the pharmacists’ surveys, an average sale of 5 - 10 PPI packages is reported per day, and around 50% are sold without a prescription. Most pharmacists were not fully aware of the health conditions and side effects of PPI drugs. On the other hand, physicians’ surveys showed that PPIs were mainly prescribed in the case of GERD and ulcer and for a maximum of 2 - 4 weeks. Approximately 75% of physicians recommend changing regimen by reducing the dose and stopping in case of chronic use of PPIs. Conclusion: The results from this survey study indicated that even though most PPI consumers at Sharjah, UAE are well aware of the use of PPI drugs and they follow the instructions given by the Physicians’, there is some discrepancy in the information obtained by the physicians, pharmacists, and patients. The reason for this discrepancy may be attributed to the missing role of the pharmacists which is currently just dispensing the medications without appropriate counseling. Thus the appropriate role of the pharmacists should be implemented according to the known international guidelines.展开更多
Aflatoxins(AFs)are frequent contaminants of herbs,which pose a health risk to regular consumers.This study quantified AFs(AFB1,AFB2,AFG1,AFG2,and Total AFs)in 100 of frequently used herbal medicine formulations in Nor...Aflatoxins(AFs)are frequent contaminants of herbs,which pose a health risk to regular consumers.This study quantified AFs(AFB1,AFB2,AFG1,AFG2,and Total AFs)in 100 of frequently used herbal medicine formulations in Northern Jordan,and assessed the health risk associated with its intake.About half of the samples had levels lower than the detection limit,while the concentrations of AFB1 and Total AFs were higher than the European limits in 10%and 23%of the collected samples,respectively.The mean average daily dose(ADD)of AFB1 through the consumption of the formulations was 3.32×10^(-6)and ranged between 1.21×10^(-9)and 0.00045 ng/kg bwt/day,while the mean ADD of Total AFs was 6.80×10^(-5)and ranged between 3.21×10^(-9)and 0.0015 ng/kg bwt/day.The margin of exposure(MOE)for each medicine herein was far greater than 10,000 as recommended by European Food Safety Authority(EFSA)for carcinogenic and genotoxic substances.Estimated cancer risk due to life time exposure to AFB1 in herbal medicines was 1.03×10^(-5)(ranged between 4.51×10^(-4)to 1.19×10^(-9)cancers/10^(5) individuals/75 year).The frequent occurrence of AFs in the analyzed samples raised questions on their potential harmful consequences on heavy consumers,and suggested that further official measures could minimize contamination and improve management of the associated cancer risk.展开更多
Introduction: Ramadan is the ninth month in the Islamic Hijri calendar where Muslims are ex-pected to fast every day from dawn to sunset. The eating behavior changes during Ramadan and the abstinence of food affects t...Introduction: Ramadan is the ninth month in the Islamic Hijri calendar where Muslims are ex-pected to fast every day from dawn to sunset. The eating behavior changes during Ramadan and the abstinence of food affects the oral drugs administration and other convenience dosage forms. There is a need to highlight and illustrate the role of the pharmacists in medication adjustment challenges that the patients conquer in the Holy month of Ramadan. Objectives: To estimate the awareness of pharmacists’ role in providing pharmaceutical care during Ramadan;moreover, to explore pharmacists’ perspective on the importance of medication regimen adjustment along with the proper counseling required to optimize patients’ health throughout fasting. Method: This is an observational study that was done through dissemination of a cross-sectional survey among 130 pharmacists covering Abu Dhabi, Dubai, Sharjah, Ajman, and Northern Emirates regions. The targeted population consisted of practicing community pharmacists and hospital pharmacists across UAE. Results: Among pharmacists participated in the study 115 pharmacists (88.5%) were Muslims and 79 pharmacists (60.8%) were Arabs. 126 pharmacists (97%) reported performing one or more kinds of medication regimen adjustment around Ramadan for at least one patient. Changing the frequency had the highest percentage by the pharmacist compared to other methods of regimen adjustment (39%). Moreover, the results revealed that 46.9% of the pharmacists chose not to change the medication itself. Nineteen percent of Muslim pharmacists initiated the conversation about medication regimen adjustment (P = 0.0448) compared to non-Muslims, while14% of pharmacists were Arabs who showed no statistically significant difference. Conclusion: In conclusion, pharmacists are more qualified to adjust and manage medication regimens than what they are presently performing. Utilization of such skill is required to adjust patients’ medication regimen during fasting the Holy month of Ramadan and to ensure safe transition for fasting patients into and out of Ramadan.展开更多
Background:Warfarin is widely regarded as the main anticoagulant in lowering the risk of thromboembolism.This study used indicators to compare pharmacist-managed anticoagulation services,using a well-prepared protocol...Background:Warfarin is widely regarded as the main anticoagulant in lowering the risk of thromboembolism.This study used indicators to compare pharmacist-managed anticoagulation services,using a well-prepared protocol,with physician-managed anticoagulation services・Methods:A retrospective prospective pilot study was conducted to compare patient outcomes before and after transitioning patients to phannacist-managed anticoagulation services,comparing the proportion of those with therapeutic international normalized ratio(INK),subtherapeutic INK,and supratherapeutic INR,as well as their bleeding occurrences as indicators of assuring quality care.Results:A significant improvement in anticoagulation management was noted in the transition to pharmacist-managed anticoagulation services.The proportion of those with subtherapeutic INR decreased from 61.8%to 11.8%(p<0.001),those with supratherapeutic INR decreased from 20.6%to 2.9%(p<0.001),those with therapeutic INR increased from 17.6%to 85.3%(p<0.001),and the occurrence of bleeding decreased from 11.8%to 0.0%,without significant difference in warfarin doses(median from 4 before the transition to 5 after);in addition,the time to reach therapeutic INR decreased from 12-24 weeks to 2-8 weeks after transitioning to pharmacist-managed anticoagulation services.Conclusion:Pharmacist-managed anticoagulation services are considered safer and more effective than physician-managed anticoagulation services alone in terms of patientsJ adherence and satisfaction,which provide an excellent opportunity for quality assurance care.展开更多
文摘Background:Diabetes and hypertension have been identified as risk factors for HCV complications in previous studies.This has sparked the interest in the field of prevention by identifying at-risk individuals and increasing investments for screening among pharmacists.The aim of this study was to screen for risk factors,including age,gender,BMI,hypertension,diabetes,and obesity,in Egyptian patients with HCV Methods:A prospective cross-sectional study was carried out from September 2018 to February 2019,with a total of 1,959 medical records collected.By comparing the patients'characteristics,variables related to metabolic risk,and body composition measurements,regression models have been established to determine any confounding factors.Results:The prevalence of HCV antibody was 41.0%in men and 59.0%in women.Among the variables included in the regression analysis,age,BMI,and uncontrolled hypertension were found to have statistically significant associations with diabetes in HCV positive cases(p<0.001).HCV patients>40 years old with high BMI were found to have significant associations with both,diabetes and hypertension(p<0.001).Hypertensive HCV patients were found to have significant associations with gender,age>40,and DM(p<0.001).Conclusion:HCV infection and metabolic disorders have a closed cycle relationship.Reducing the complications of DM has a promising prospective of limiting the complications of HCV .
文摘Alzheimer’s disease (AD) is a neurodegenerative disorder that is characterized by progressive loss of memory, confusion, inability of speech and decline in the cognitive behavior. It is considered one of the most common forms of dementia. Clinical studies and preclinical data in the last decade proved that AD and Diabetes mellitus share a pathophysiological pathway, indicating that insulin resistance, oxidative stress and inflammatory response would increase the risks of developing AD in diabetic patients. This review presents briefly the etiology of AD and Diabetes, discusses the possible theories about the interplaying risk factors and the mechanism of action of anti-diabetic medications recommended for the treatment of AD. It is concluded that antidiabetics have good potential to improve dementia, especially in earlier AD stages. However, many of the underlying intricate molecular pathways are still unclear and thus thorough future research is required.
文摘Objectives: The objective of this study was to evaluate the knowledge and perceptions of patients towards generic medicines in some Emirates of the United Arab Emirates. Methods: A cross-sectional survey involving patients in three Emirates was undertaken. A 23-item questionnaire was designed, pre-validated and administered. Results: The questionnaire was fully answered by 96 patients out of 120 producing a response rate of 80%. The majority of patients were young Arab females with a university degree. Slightly less than 50% of patients were having a monthly income of less than ED 10,000. Results of the patient’s survey indicate that they have poor knowledge and perception of generic medicines. They did not know the meaning of generic or brand medicines and this negatively influenced their responses to consequent questions. Conclusion: Patients’ knowledge and perception of generic drugs were poor. Efforts are needed to increase public awareness of generic drugs and possible brand substitution. Both the prescribing physician and the dispensing pharmacists have an essential role to play in educating their patients of generic drugs.
文摘The present study aims to investigate the perceptions and experience of physicians regarding the clinical role of the pharmacists. This is an observational study that was conducted during the period of September 2013 through March 2014. A self-administered questionnaire was designed to be distributed by personal interview to the physicians. The questionnaire population consisted of randomly selected physicians practicing in UAE. The questionnaire was piloted by 10 physicians for face and understandability. Demographic data, frequencies and cross tabulation between different variables were calculated. The Chi-square test was used to determine the significance of association between categorical variables (gender, length of medical practice, and specialty) and the perception of physicians. A total of 285 filled questionnaires were returned representing 285 physicians, with a male dominance (65.3%). The average age of the physician screened was 32.4 (SD = 10.38) years with a minimum one year experience and up to 24 years. General practitioners consumed the widest sector (21.8%) followed by cardiologists (15.8%), then internal medicine (10.1%). In the current study, two thirds of the physicians believed that pharmacists could act as a reliable source of general drug information and play an important role in discovering clinical related problems. It was found that the physicians who had fewer years in practice (less than 10 years) and recently graduated had more acceptances to the clinical role of the pharmacist and believed that there should be a clinical pharmacy services in their hospitals (p-value < 0.05). No other statistically significant differences were found from analyzing the data. In conclusion, results suggest that physicians in UAE appear comfortable with pharmacists providing the broad range of services but appear somewhat less comfortable with pharmacists’ provision of direct patient care.
文摘Patient care in a community is becoming critical due to change in the impact of diseases on health. The provision of pharmaceutical care in a community will bring in positive changes in health care delivery. However, the pharmacist in developing countries has remained obscure in direct health- care of the patient. The main aim of this article is to reinforce the concept that there is a need to strengthen the basic pharmaceutical system in the Arab and African world before implementing any advanced clinical pharmacy or pharmaceutical care services to our communities. This article gives a good insight of where pharmacy practice in Arab, African and other developing countries globally stand in comparison to developed nations. A trend is apparent towards increased emphasis on clinical pharmacy practice. Country-specific pharmacy education and practice are discussed, analyzing the progress and opportunities available to pharmacy graduates. In addition, the future of pharmacy practice and clinical roles of hospital and community pharmacists were reviewed. It was realized that pharmacy practice and progress in many of the Arab and African countries were a mirror image of the status of the country itself. A new vision for the future of pharmacy practice needs to be considered and reorientation of pharmacy services in the existing system is needed. There should be a professional approach to speed up the rise towards practicing clinical pharmacy and pharmaceutical profession. This is achieved by interviewing patients, documenting their health details and educating them on methods of improving their health, including proper medication usage and lifestyle modification. Furthermore, colleges of pharmacy need to revise and update their curricula to accommodate the progressively increasing development in the pharmaceutical education and the evolving new roles of practicing pharmacists in their community.
文摘Background: Proton pump inhibitors (PPIs) are drugs that reduce the production of acid in the stomach. Recently, the use of PPI has been increasing among communities, whether with or without prescription. As a part of the healthcare team, the pharmacist should not only dispense medications but also ensure the appropriate use of these medications. Studies conducted within 16 countries showed substantial variation in the appropriateness of the use of PPI drugs. Aim: To evaluate the appropriateness of PPIs use in Sharjah, UAE based on surveys answered by pharmacists, physicians, and patients. Methods: A cross-sectional survey study was conducted on December 2017 at Sharjah, UAE as an example of information obtained from the Middle East. Two different surveys were conducted on physicians and pharmacists. Both Physicians and Pharmacists were chosen randomly from Yellow Pages. The results obtained from both studies were used to develop a patient’s survey, which was distributed among University of Sharjah students, their families and random people at Shopping Malls and Clinics. Results: The results obtained from the patients’ survey showed that ~39% of PPI users from the region of Sharjah are 25 - 44 years old. Approximately 79% are using PPI according to physicians’ prescriptions. Prescriptions’ duration is varied between 1 month (39%) and 6 months (22%), where 52% of PPI users ask their physicians to prescribe PPIs when needed. Suggested reasons for the use of PPI included inappropriate food habits (52%), use of other medications (16%) or bacterial infection (13%). Around 52% of the patients did not receive any recommendations regarding the deprescribing of PPIs. According to the pharmacists’ surveys, an average sale of 5 - 10 PPI packages is reported per day, and around 50% are sold without a prescription. Most pharmacists were not fully aware of the health conditions and side effects of PPI drugs. On the other hand, physicians’ surveys showed that PPIs were mainly prescribed in the case of GERD and ulcer and for a maximum of 2 - 4 weeks. Approximately 75% of physicians recommend changing regimen by reducing the dose and stopping in case of chronic use of PPIs. Conclusion: The results from this survey study indicated that even though most PPI consumers at Sharjah, UAE are well aware of the use of PPI drugs and they follow the instructions given by the Physicians’, there is some discrepancy in the information obtained by the physicians, pharmacists, and patients. The reason for this discrepancy may be attributed to the missing role of the pharmacists which is currently just dispensing the medications without appropriate counseling. Thus the appropriate role of the pharmacists should be implemented according to the known international guidelines.
基金funded by the Deanship of Research at Jordan University of Science and Technology [grant No.20190303].
文摘Aflatoxins(AFs)are frequent contaminants of herbs,which pose a health risk to regular consumers.This study quantified AFs(AFB1,AFB2,AFG1,AFG2,and Total AFs)in 100 of frequently used herbal medicine formulations in Northern Jordan,and assessed the health risk associated with its intake.About half of the samples had levels lower than the detection limit,while the concentrations of AFB1 and Total AFs were higher than the European limits in 10%and 23%of the collected samples,respectively.The mean average daily dose(ADD)of AFB1 through the consumption of the formulations was 3.32×10^(-6)and ranged between 1.21×10^(-9)and 0.00045 ng/kg bwt/day,while the mean ADD of Total AFs was 6.80×10^(-5)and ranged between 3.21×10^(-9)and 0.0015 ng/kg bwt/day.The margin of exposure(MOE)for each medicine herein was far greater than 10,000 as recommended by European Food Safety Authority(EFSA)for carcinogenic and genotoxic substances.Estimated cancer risk due to life time exposure to AFB1 in herbal medicines was 1.03×10^(-5)(ranged between 4.51×10^(-4)to 1.19×10^(-9)cancers/10^(5) individuals/75 year).The frequent occurrence of AFs in the analyzed samples raised questions on their potential harmful consequences on heavy consumers,and suggested that further official measures could minimize contamination and improve management of the associated cancer risk.
文摘Introduction: Ramadan is the ninth month in the Islamic Hijri calendar where Muslims are ex-pected to fast every day from dawn to sunset. The eating behavior changes during Ramadan and the abstinence of food affects the oral drugs administration and other convenience dosage forms. There is a need to highlight and illustrate the role of the pharmacists in medication adjustment challenges that the patients conquer in the Holy month of Ramadan. Objectives: To estimate the awareness of pharmacists’ role in providing pharmaceutical care during Ramadan;moreover, to explore pharmacists’ perspective on the importance of medication regimen adjustment along with the proper counseling required to optimize patients’ health throughout fasting. Method: This is an observational study that was done through dissemination of a cross-sectional survey among 130 pharmacists covering Abu Dhabi, Dubai, Sharjah, Ajman, and Northern Emirates regions. The targeted population consisted of practicing community pharmacists and hospital pharmacists across UAE. Results: Among pharmacists participated in the study 115 pharmacists (88.5%) were Muslims and 79 pharmacists (60.8%) were Arabs. 126 pharmacists (97%) reported performing one or more kinds of medication regimen adjustment around Ramadan for at least one patient. Changing the frequency had the highest percentage by the pharmacist compared to other methods of regimen adjustment (39%). Moreover, the results revealed that 46.9% of the pharmacists chose not to change the medication itself. Nineteen percent of Muslim pharmacists initiated the conversation about medication regimen adjustment (P = 0.0448) compared to non-Muslims, while14% of pharmacists were Arabs who showed no statistically significant difference. Conclusion: In conclusion, pharmacists are more qualified to adjust and manage medication regimens than what they are presently performing. Utilization of such skill is required to adjust patients’ medication regimen during fasting the Holy month of Ramadan and to ensure safe transition for fasting patients into and out of Ramadan.
文摘Background:Warfarin is widely regarded as the main anticoagulant in lowering the risk of thromboembolism.This study used indicators to compare pharmacist-managed anticoagulation services,using a well-prepared protocol,with physician-managed anticoagulation services・Methods:A retrospective prospective pilot study was conducted to compare patient outcomes before and after transitioning patients to phannacist-managed anticoagulation services,comparing the proportion of those with therapeutic international normalized ratio(INK),subtherapeutic INK,and supratherapeutic INR,as well as their bleeding occurrences as indicators of assuring quality care.Results:A significant improvement in anticoagulation management was noted in the transition to pharmacist-managed anticoagulation services.The proportion of those with subtherapeutic INR decreased from 61.8%to 11.8%(p<0.001),those with supratherapeutic INR decreased from 20.6%to 2.9%(p<0.001),those with therapeutic INR increased from 17.6%to 85.3%(p<0.001),and the occurrence of bleeding decreased from 11.8%to 0.0%,without significant difference in warfarin doses(median from 4 before the transition to 5 after);in addition,the time to reach therapeutic INR decreased from 12-24 weeks to 2-8 weeks after transitioning to pharmacist-managed anticoagulation services.Conclusion:Pharmacist-managed anticoagulation services are considered safer and more effective than physician-managed anticoagulation services alone in terms of patientsJ adherence and satisfaction,which provide an excellent opportunity for quality assurance care.
