The purpose of this study is to compare the effectiveness of prescribing oral anticoagulation therapy by pharmacist intervention compared to enhanced usual care in participants with unrecognized AF and/or known AF but not taking blood thinners.
AF is the most common arrhythmia and the leading cause of stroke. Despite robust evidence oral anticoagulation (OAC) therapy is effective and safe for stroke prevention in patients with AF; there is a lack of real-world application. Alternative strategies to deliver stroke prevention therapy need to be explored. Although pharmacists' prescribing of antihypertensive and lipid lowering drug therapy has been shown to increase adherence to guideline-based targets and warfarin management improve control of international normalized ratios in anticoagulation clinics, the role of pharmacist initiation of OAC therapy compared to usual care in AF patients for stroke prevention in a community setting is unclear.
In this study, the investigators will screen participants presenting to community pharmacies to identify participants with unrecognized AF and/or known AF but not taking blood thinners or not on optimal OAC therapy and randomize care to either the pharmacist or enhanced usual care (family physician notification by pharmacist).
- Anticoagulants Drug
Other Names: warfarin and novel oral anticoagulants Intervention Desc: Anticoagulant therapy will be initiated/titrated in patients with atrial fibrillation in accordance with the Canadian Cardiovascular Society Guidelines for Atrial Fibrillation. ARM 1: Kind: Experimental Label: Active Pharmacist Arm Description: OAC therapy will be initiated/adjusted by the community pharmacist in accordance to the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. ARM 2: Kind: Experimental Label: Enhanced Usual Care Arm Description: Pharmacist will be refer participants to their physician in regards to OAC therapy for atrial fibrillation. The pharmacist will provide a current medication list to the physician as well as notification of a new diagnosis of atrial fibrillation
|Type||Measure||Time Frame||Safety Issue|
|Primary||Optimal Oral Anticoagulant (OAC) Therapy for Atrial Fibrillation Stroke Prevention||3 months|
|Secondary||Prevalence of AF||Through study completion, an average of 1 year|
|Secondary||Patient Satisfaction with Pharmacists Services||3 months|
|Secondary||Qualitative Assessment of Implementation by Pharmacist||Through study completion, an average of 1 year|
|Secondary||Healthcare Utilization||One year|