Delivering specialist expertise in anticoagulation initiation in the primary care setting; harnessing the skills of Specialist Pharmacists in the prevention of AF related stroke

Providing anticoagulation therapy to patients with Atrial Fibrillation (AF) is a role that has traditionally sat in General Practice. The introduction of 4 NOACs to the market, each with specific contraindications, side effects and dosing regimens has markedly increased the complexity of this area of pharmacology placing a significant burden on the GP to communicate complex information on the risks and benefits of anticoagulation and each drug to patients within a traditional 10-minute appointment slot.

 

Key issues that need to be addressed to ensure that sustainable step changes in anticoagulation rates are achieved are:

 Confidence and expertise in initiating anticoagulation

 Capacity in primary care to have detailed and prolonged conversations with patientsabout risks and benefits

 

We propose to address these issues through developing and evaluating a novel model of anticoagulation initiation, within the primary care setting, harnessing the specific expertise of Specialist Pharmacists to counsel patients, assess bleeding and stroke risk and use shared decision making techniques to decide on appropriate anticoagulation. The Specialist Pharmacists will prescribe the first month’s anticoagulation after which patients are managed through usual GP monitoring. Patients prescribed a NOAC will be offered a follow-up appointment to discuss side effects and all patients will have access to a telephone helpline, which GPs can also access if they have on-going queries. This system based change project will establish a model that can be rapidly spread across the NHS.