Pharmacist-Staffed Coagulation Clinics in a Large Health System

The March 20, 2006, issue of The Dark Report (link here; fees for articles) contained a very interesting article about the deployment of pharmacist-staffed coagulation clinics in the Geisinger Health System service areas in northeastern and central Pennsylvania. Here is the home page for Geisinger. The ability of Geisinger's lab division to support such clinics is related to its integrated system-wide informatics capabilities and also its well deserved reputation as a national leader in point-of-care testing (POCT). Here is a link to a lecture by Dr. Jay Jones about Geisinger's point-of-care program.

As a result of this coagulation clinic program, patients receiving anticoagulation therapy at Geisinger are reported to have experienced a reduction of bleeding episodes of 79% and of recurrent thrombotic events of 89% over the six years that the program has been in place.

There are a total of six Geisinger pharmacist-staffed coagulation clinics -- one located in the flagship hospital and five in the largest primary practice sites scattered across the entire service area. Each site with a coagulation clinic also maintains a clinical laboratory. All testing done in the coagulation clinic is integrated with the on-site laboratory. The patient's physician refers the patient to the pharmacist with three objectives: (1) drug therapy management; (2) patient education; and (3) drug dosage adjustment.

Here are my thoughts about this excellent program:

• I have some indirect experience about coagulation clinics and their lab/IT support. This is a complex clinical activity and not for the faint-hearted. Treating these patients requires strict attention to detail and efficient systems. However, the clinical outcomes, as noted above, can be excellent.
• The Geisinger system is to be commended on their planning ability and capital investment in these coagulation clinics. My sense is that this is a project that could only be achieved by a sophisticated health delivery system with a competent clinical lab and information technology team. I have published notes previously about walk-in clinics located in chain pharmacies and big-box stores (links here and here and here) but I doubt that the companies operating these clinics would be interested in monitoring anticoagulated patients.
• I believe that pharmacists tend to be underutilized in  health delivery network clinical settings. The Gesinger program is an excellent demonstration of how these professionals can deliver valuable clinical services. However, my understanding is that it is difficult for hospitals to compete with the drug store chains in recruiting pharmacists. It is possible that the Geisinger program could not be duplicated in large urban areas.