A PHARMACIST-PHYSICIAN initiative aimed at patients with atrial fibrillation (AF) has boosted blood thinner uptake among patients deemed high risk for stroke in regional Victoria.
The rapid access atrial fibrillation (RAAF) clinic situated at Grampians Health Ballarat operated between Apr 2022 and Nov 2023.
The model involved patients receiving an initial consult with a specialist cardiology pharmacist via telehealth, followed by a face-to-face or telehealth consultation with a general medicine physician with experience working in stroke clinics.
Written information on AF and relevant medications was emailed or posted to patients, based on their preference.
During the study period, waiting times for appointments reduced from a median of 224 days to 14 days; the proportion of patients who received blood-thinning medications for stroke prevention increased from 88% (pre-clinic) to 97% (post-clinic); and further therapy optimisation occurred in 35% of patients overall.
The research team, led by Adam Livori, a Grampians Health clinical pharmacist and PhD candidate, also found the RAAF clinic improved guideline concordant care and had high levels of patient satisfaction.
Livori said AF is increasingly a major cause of hospital admissions globally, and people in regional areas of Australia with less access to specialist care had lower uptake of timely treatment.
"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," Livori said.
"However, Australian data has shown low uptake of timely interventions, with people in regional areas having a greater risk of low uptake compared to people in metropolitan areas.
"There is evidence that RAAF clinics internationally and within Australia via a cardiologist-led model can lead to reduced hospitalisation 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.
Livori said this needs to change.
"Our findings highlight how regional health centres can utilise the existing skillsets of onsite pharmacists and physicians to enhance and accelerate access to critical patient interventions and treatment programs."
A health economic analysis of the RAAF clinic will explore how the service impacts stroke risk with consideration of service costs and future implementation.
The study is available HERE. KB
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