A regional health centre within Victoria has managed to boost blood-thinner uptake among patients deemed high risk for stroke following a pharmacist-physician initiative aimed at patients with atrial fibrillation (irregular heart rhythms).
In this retrospective study, led by researchers from the Center for Medicine Use and Safety (CMUS) within the Monash Institute of Pharmaceutical Sciences and Grampians Health, the team used quantitative and qualitative methods to evaluate the pharmacist-physician model of care for a rapid access atrial fibrillation (RAAF) clinic.
The RAAF clinic was situated at Grampians Health Ballarat and operated between April 2022 and November 2023.
The study demonstrated wait times for appointments were reduced from a median of 224 days to 14 days during the study period. Additionally, the proportion of patients who received blood thinning medications for stroke prevention increased from 88 per cent (pre-clinic) to 97 per cent (post-clinic), with further therapy optimisation occurring in 35 per cent of patients overall.
The research team – led by Adam Livori, a Grampians Health pharmacist and CMUS PhD candidate – also found the RAAF clinic improved guideline concordant care and had high levels of patient satisfaction.
Mr Livori said atrial fibrillation is increasingly a major cause of hospital admissions, with its global prevalence increasing by a staggering 146 per cent from 1990 to 2019.
"Timely access to care is particularly important in atrial fibrillation, given that longer periods without blood thinning medications lead to a higher cumulative risk of stroke and therefore a higher likelihood of life-limiting symptoms. However, Australian data have shown low uptake of timely interventions, with people in regional areas having a greater risk of low uptake compared to people in metropolitan areas," Mr Livori said.
"There is evidence that RAAF clinics internationally and within Australia via a cardiologist led model can lead to reduced hospitalization and death via early investigation and treatment, but many of the previous studies were conducted in major cities where there is greater access to cardiologists than in regional areas.
"This needs to change. Our findings highlight how regional health centres can utilise the existing skill-sets of on-site pharmacists and physicians to enhance and accelerate access to critical patient interventions and treatment programs."
A health economic analysis of the RAAF clinic is underway, which will explore how the service impacts stroke risk with consideration of service costs and future implementation.
Research:
This study is published in Research in Social and Administrative Pharmacy.
DOI: https://doi.org/10.1016/j.sapharm.2025.03.005
Adam C. Livori, Rasantha Kuruppumullage, Mardi Simmons, Aili Langford, Zanfina Ademi MPharm, J. Simon Bell, Renee Dimond, Jedidiah I. Morton
