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Moving anticoagulation initiation and monitoring services into the community: Evaluation of the Brighton and hove community pharmacy service

Ingram, Samantha J.; Kirkdale, Charlotte L.; Williams, Sian; Hartley, Elaine; Wintle, Susan; Sefton, Valerie; Thornley, Tracey


Samantha J. Ingram

Charlotte L. Kirkdale

Sian Williams

Elaine Hartley

Susan Wintle

Valerie Sefton


Background: As part of the NHS desire to move services closer to where people live, and provide greater accessibility and convenience to patients, Brighton and Hove Clinical Commissioning Group (CCG) underwent a review of their anticoagulation services during 2008. The outcome was to shift the initiation and monitoring service in secondary care for non-complex patients, including domiciliary patients, into the community. This was achieved via a procurement process in 2008 resulting in the Community Pharmacy Anticoagulation Management Service (CPAMs) managed by Boots UK (a large chain of community pharmacies across the United Kingdom). Methods: This evaluation aims to review the outcomes (International Normalised Ratio [INR] readings) and experiences of those patients attending the anticoagulation monitoring service provided by community pharmacists in Brighton and Hove. All patients on warfarin are given a target INR range they need to achieve; dosing of and frequency of appointment are dependent on the INR result. Outcome measures for patients on the CPAM service included percentage INR readings that were within target range and the percentage time the patient was within therapeutic range. Data collected from 2009 to 2016 were analysed and results compared to the service targets. Patient experience of the service was evaluated via a locally developed questionnaire that was issued to patients annually in the pharmacy. Results: The evaluation shows that community pharmacy managed anticoagulation services can achieve outcomes at a level consistently exceeding national and local targets for both percentage INR readings in therapeutic target range (65.4%) compared to the recommended minimum therapeutic target range of 60.0% and percentage time in therapeutic range (72.5%, CI 71.9-73.1%) compared to the national target of 70.0%. Patients also indicated they were satisfied with the service, with over 98.6% patients rating the service as good, very good or excellent. Conclusion: The Brighton and Hove CPAM service achieved above average national target management of INR and positive patient feedback, demonstrating that community pharmacy is ideally placed to provide this service safely and deliver enhanced clinical outcomes and positive patient experience.


Ingram, S. J., Kirkdale, C. L., Williams, S., Hartley, E., Wintle, S., Sefton, V., & Thornley, T. (2018). Moving anticoagulation initiation and monitoring services into the community: Evaluation of the Brighton and hove community pharmacy service. BMC Health Services Research, 18(1), Article 91.

Journal Article Type Article
Acceptance Date Jan 30, 2018
Online Publication Date Feb 7, 2018
Publication Date 2018
Deposit Date Jan 14, 2023
Publicly Available Date Jan 20, 2023
Journal BMC Health Services Research
Electronic ISSN 1472-6963
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 18
Issue 1
Article Number 91
Public URL
Publisher URL


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