Implementation of a medication assessment tool for long-term management of atrial fibrillation

Abstract

Background and Objective: Optimisation of drug therapy is essential in the care of older persons and may be facilitated by implementation of medication assessment tools (MATs). The objective was to assess whether implementation of an innovatively developed validated MAT for the long-term management of atrial fibrillation (MAT-AF) in clinical practice contributes to optimisation of drug therapy and clinical pharmacist intervention. Setting and Method: Adherence to MAT-AF was tested by the researcher (pre-MAT implementation) in a sample of 150 patients aged ≥ 60 years admitted to a rehabilitation hospital with a diagnosis of atrial fibrillation. The pharmacy patient profile of each patient was reviewed by the researcher to assess clinical pharmacist intervention documentation. MAT-AF was introduced as a clinical tool for identification of pharmaceutical care issues in atrial fibrillation patients. Adherence to MAT-AF and pharmacist intervention documentation were assessed by the researcher (post-MAT implementation) for a further 150 patients. The ‘differences between two population proportions z-test’ was used to compare adherence to MAT-AF and pharmacist intervention pre- and post-MAT implementation. Main outcome measures: Adherence to MAT-AF review criteria; documentation of clinical pharmacist interventions on pharmacy patient profile. Results: Adherence to MAT-AF review criteria increased from 71.0% (95% CI 66.9, 75.1) pre-implementation to 89.6% (95% CI 86.9, 92.3) post-implementation (z-score 7.089, p\0.001). MAT-AF implementation resulted in a significant improvement in prescription of anticoagulation in patients with a CHA2DS2VASc score ≥ 1 (zscore 4.416, p \ 0.001), monitoring of laboratory parameters for digoxin (z-score 4.793, p \ 0.001), ophthalmic and pulmonary monitoring for amiodarone (z-score 2.426, p = 0.015) and referral to cardiologists for patients on antiarrhythmic agents but not maintained in sinus rhythm (z-score 1.992, p = 0.047). Clinical pharmacist intervention improved significantly post-implementation of MAT-AF (z-score 20.249, p\0.001). Conclusion: Implementation of MAT-AF within an interdisciplinary health care team significantly improved the quality of drug therapy and pharmacist intervention in older persons admitted to a rehabilitation hospital.