Presentation Details
| Antithrombotic Stewardship and Health Equity in Peripheral Artery Disease Kelly M.Rudd1, 2, Kristie K.Roberts1, Cooper M.Hamilton2. 1Oklahoma State University Center for Health Sciences Center College of Osteopathic Medicine, Tulsa, OK, USA.2Oklahoma State University Center for Health Sciences Center College of Osteopathic Medicine, Tahlequah, OK, USA |
Abstract
Background: Peripheral Artery Disease (PAD) is an atherosclerotic disease which contributes to significant morbidity and mortality, including loss of limb, myocardial infarction, stroke, and death. Effective therapies to reduce PAD events are significantly underused, with the rates of amputations growing, particularly among African Americans, Hispanics, and Native Americans. A major limiting factor to providing early intervention is the ability to efficiently identify and screen at-risk patients.
Objectives: 1) To initiate a PAD Antithrombotic Stewardship Practice, as an extension of the current Anticoagulation (warfarin) Clinic within an Indian Health Service hospital caring exclusively for Native American individuals, which 2) efficiently identifies and screens at-risk individuals, receives clinical consultations from facility providers, and provides PAD disease severity staging and evidence-based therapy initiation, when appropriate, while 3) delivering care and patient education in a culturally competent manner and with the utmost dignity and respect.
Methods: Evidence-based literature and clinical guidance documents were curated and utilized to develop a PAD patient screening and clinician decision support tool. The major PAD tool development goals were to improve access to high-quality, evidence-based care to drive improved clinical outcomes, while being adaptable for use across multiple care settings, by varied health professions, outside of this stewardship initiative. Clinical infrastructure was created to extend the services of the current pharmacist-led Anticoagulation Clinic to offer the PAD Antithrombotic Stewardship services. This included implementing an expanded pharmacist collaborative drug-therapy management agreement, establishing a registration system specific for PAD care, creation of a standardized patient care note within the electronic health record (EHR), and securing coding and billing of clinical services. At-risk individuals were identified via EHR query, which assessed the problem list of current patients for history of diabetes, tobacco use and/or inclusion of the EHR preset designations for vascular disease or claudication.
Results: Over 1,600 patients were identified by electronic health record query as meeting the predefined clinical criteria. Patient outreach began in January 2024 by the Anticoagulation Clinic pharmacist, offering PAD screening within the newly established clinic. The developed PAD Patient Screening and Clinical Decision Support Tool has been effectively utilized to drive PAD diagnosis, risk assessment, and pharmacologic treatment, while assisting in organizing information for EHR documentation. High-quality patient education materials, as developed by the American Heart Association, are utilized in patient education. Preliminary outcome data is not available at the time of abstract submission. The developed tool has subsequently been effectively utilized in several diverse settings, with high rates of patient and provider acceptance.
Conclusion: The implementation of a PAD screening and treatment tool enhances anticoagulation and PAD stewardship and has demonstrated the ability to be effectively translated into use across various care settings to improve patient care in an at-risk population. The adaptation of a PAD Tool into a pharmacist-led anticoagulation clinic has allowed for effective and efficient identification of previously undiagnosed PAD, led to initiation of guideline driven antithrombotic therapy, while achieving high rates of patient and provider acceptance.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
Objectives: 1) To initiate a PAD Antithrombotic Stewardship Practice, as an extension of the current Anticoagulation (warfarin) Clinic within an Indian Health Service hospital caring exclusively for Native American individuals, which 2) efficiently identifies and screens at-risk individuals, receives clinical consultations from facility providers, and provides PAD disease severity staging and evidence-based therapy initiation, when appropriate, while 3) delivering care and patient education in a culturally competent manner and with the utmost dignity and respect.
Methods: Evidence-based literature and clinical guidance documents were curated and utilized to develop a PAD patient screening and clinician decision support tool. The major PAD tool development goals were to improve access to high-quality, evidence-based care to drive improved clinical outcomes, while being adaptable for use across multiple care settings, by varied health professions, outside of this stewardship initiative. Clinical infrastructure was created to extend the services of the current pharmacist-led Anticoagulation Clinic to offer the PAD Antithrombotic Stewardship services. This included implementing an expanded pharmacist collaborative drug-therapy management agreement, establishing a registration system specific for PAD care, creation of a standardized patient care note within the electronic health record (EHR), and securing coding and billing of clinical services. At-risk individuals were identified via EHR query, which assessed the problem list of current patients for history of diabetes, tobacco use and/or inclusion of the EHR preset designations for vascular disease or claudication.
Results: Over 1,600 patients were identified by electronic health record query as meeting the predefined clinical criteria. Patient outreach began in January 2024 by the Anticoagulation Clinic pharmacist, offering PAD screening within the newly established clinic. The developed PAD Patient Screening and Clinical Decision Support Tool has been effectively utilized to drive PAD diagnosis, risk assessment, and pharmacologic treatment, while assisting in organizing information for EHR documentation. High-quality patient education materials, as developed by the American Heart Association, are utilized in patient education. Preliminary outcome data is not available at the time of abstract submission. The developed tool has subsequently been effectively utilized in several diverse settings, with high rates of patient and provider acceptance.
Conclusion: The implementation of a PAD screening and treatment tool enhances anticoagulation and PAD stewardship and has demonstrated the ability to be effectively translated into use across various care settings to improve patient care in an at-risk population. The adaptation of a PAD Tool into a pharmacist-led anticoagulation clinic has allowed for effective and efficient identification of previously undiagnosed PAD, led to initiation of guideline driven antithrombotic therapy, while achieving high rates of patient and provider acceptance.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.