Development of Integrated Pharmaceutical Care Model for Atrial Fibrillation Patients with Warfarin at Phimai Hospital, Nakhon Ratchasima Province

Abstract

Background: Since the establishment of the warfarin clinic in 2012, Phimai Hospital has reported that fewer than 65% of patients maintained an international normalized ratio (INR) within the target range. To enhance anticoagulation outcomes, an integrated pharmaceutical care model was developed.

Objective: To develop and evaluate the effectiveness of an integrated pharmaceutical care model using telephone follow-up among patients with atrial fibrillation receiving warfarin therapy at Phimai Hospital, Nakhon Ratchasima Province.

Methods: This quasi-experimental study was conducted among outpatients with atrial fibrillation receiving warfarin therapy from June 1, 2024, to February 28, 2025. Participants were purposefully selected if a dose adjustment occurred during physician visits and they were able to communicate with pharmacists by telephone. Data collection tools included patient questionnaires, treatment records, and medication-related problem assessments. Descriptive statistics were used to summarize patient characteristics, while inferential analyses were performed using paired t-tests and the McNemar test.

Results: The number of patients achieving target INR increased significantly from 0 to 60 (70.59%; p < 0.001). Mean warfarin knowledge scores improved from 11.80 ± 2.24 to 14.05 ± 1.09 (p < 0.001). Medication-related problems decreased from 63 to 1 incident (p < 0.001). Patient satisfaction was high (4.88 ± 0.39 out of 5), and physicians accepted 97.65% of pharmacists’ therapy adjustment recommendations.

Conclusion: The integrated pharmaceutical care model significantly increased the proportion of patients achieving target INR, reduced medication-related problems, and enhanced patient satisfaction. Implementation of this model is recommended in similar clinical settings.