Anticoagulation clinic celebrates 10-year milestone
Jan Akus, MD, Medical Director of the Backus Anticoagulation Clinic. |
Carol Savluk, RPh, cares for a patient. |
Backus Hospital's Anticoagulation Clinic opened with little fanfare in April 1997, with 35 patient visits in the first month.
A decade later, the award-winning clinic handles more than 1,600 visits a month and has made a difference in the lives of thousands of patients.
"This is a great success story for Backus," said Les Temkin, Vice President, Administrative Services, who along with Susan Johnson, PharmD, played a major role in establishing the clinic 10 years ago this month. "It clearly demonstrates the hospital's commitment to improving healthcare in our community."
The clinic was actually offering "preventative care" before it became the popular catchphrase it is today.
"The clinic continues to focus its efforts on preventative care," Mr. Temkin added. "Working with the patients as a team to help maintain their drug levels in the appropriate range leads to better outcomes by reducing the potential for adverse events such as strokes."
Jan Akus, MD, Medical Director of the clinic, said the therapeutic window for the blood-thinning drug warfarin (more commonly known by its brand-name, Coumadin) is very narrow.
"It can't be too high or too low," he said. If it is too low, patients can be susceptible to clotting, but if it is too high, then there is a risk of internal bleeding.
More than 900,000 people in the U.S. are estimated to develop clots every year. Of these, 380,000 develop deep-vein thrombosis, which is a clot that occurs commonly in the inner veins of the leg. Clots can also form due to prosthetic heart valves or atrial fibrillation (a type of abnormal heart rhythm). Clots from these sources often develop into a stroke. Warfarin is prescribed to patients who have recently developed a clot or at a high risk of forming one.
Because of the delicate balance needed when treating patients with Warfarin, Dr. Akus said patients need to have their clotting levels checked often. The best-case scenario is once a month, but if they are new to the medication or have widely fluctuating levels, the test may be needed more often to keep the medication in the appropriate range. In the clinic the test is commonly done as a simple finger-prick, with the results available in less then two minutes and the staff can immediately review it with patients.
Michael Smith, PharmD, RPh, a pharmacist and clinical director of the clinic, said in the 10 years the clinic has been open, 2,800 patients have been treated, and there are currently about 1,000 active patients. The staff, which includes two receptionists and four care providers, includes a mix of specially trained nurses and pharmacists.
"We started the clinic based on observed need," Dr. Smith said. "The hospital noticed there were patients who were not on the medication they should have been, and some who weren't receiving optimal care."
Members of the Anticoagulation Clinic team, from left: Jan Akus, MD; Michael Smith, PharmD, RPh; Victoria Lambert, PharmD, CAPP; Dan Antell, APRN; Carol Savluk, RPh; Eric Remillard, receptionist; Karen Stedman, APRN; and Michelle Bychowsky, receptionist. |
The dramatic increase in patients over the years is partly due to an aging population and also because the benefits of a specialized anticoagulation clinic are more accepted and understood now — by both patients and doctors.
"It is a unique medication, because the dose is so individualized," Dr. Smith said.
Factors that can have an impact on the levels include age, diet, genetic makeup and interaction with other medications.
The clinic has been recognized for its excellence on several occasions. It has received a Silver Innovation Prize from the Connecticut Quality Improvement Award Partnership in 1999, and the prestigious DREAM Award (Dream of Reaching Excellence in Anticoagulation Management Award) from Roche Diagnostics in 2002. Only about 20 anticoagulation clinics in the country have achieved this distinction.