Community Healthcare System centralizes monitoring, treatment for patients on blood thinners
It’s not unusual for health care patients to have appointments at different facilities for one condition.
Recognizing this, Community Healthcare System has streamlined the process in caring for patients who need blood thinners, or anticoagulants, the administration of which often requires careful choreography, says Michelle Meyer, pharmacy director at St. Mary Medical Center’s anticoagulant clinic in Hobart.
The Hobart clinic, opened in July 2016, is one of Community Healthcare System’s three anticoagulant clinics along with one at St. Catherine Hospital in East Chicago, opened in spring 2017, and Community Hospital’s in Munster, opened in 2009, that centralize patient monitoring.
Convenience and comprehensive treatment are behind the moves. The St. Catherine clinic, for example, was moved from the infusion clinic to the hospital’s redesigned outpatient retail pharmacy in the professional office building. “That makes it more convenient, comfortable, efficient and accessible for our patients, especially those who are in wheelchairs or use canes,” says pharmacy director Koula Tsahas. “Patients love it because it’s right by the door. And they can go to a doctor’s office and pick up their medicine, all in one building.”
At the St. Mary Medical Center anticoagulant clinic, patients can visit doctors in other offices and have lab work done, says Meyer.
Blood thinners commonly are prescribed:
• Following a heart attack
• Following a stroke
• For coagulation disorders
• With artificial heart valves
• For atrial fibrillation (irregular heartbeat)
• For treatment or prevention of deep vein thrombosis (blood clot in a large vein, most commonly in the leg) or pulmonary embolism (blood clot in the lungs)
But regulation of blood thinners — the clinics focus on warfarin, brand name Coumadin — and their side effects can be tricky, affected by something as simple as a change in diet, says Jonathan Guerrero, head of the St. Mary clinic.
“That’s why our clinic services are comprehensive. With issues like diet, for example, we tend to be a little more probing with questions so we can make sure they’re following their anticoagulant therapy,” says Guerrero. Foods such as green leafy vegetables can upset the blood thinner balance. “As patients get more comfortable with us from seeing us more often, they can talk to us about a new medication, for example, in a way they didn’t get to with a retail pharmacist,” says Guerrero.
Elizabeth Clements, director of Community Hospital’s pharmacy at the anticoagulation clinic, says services include lab tests, medication adjustments and addressing dieting and bleeding concerns and drug interactions. Doing that frequently is essential, says Guerrero: “Patients have told us they’ve only been checked every three or four months, but here we schedule appointments every four to six weeks.”
The clinics monitor the patient’s INR (international normalized ratio) level with a finger prick blood test. INR indicates how long it takes for the patient’s blood to clot. The higher the INR score, the longer it takes, the greater the risk of abnormal bleeding.
Alex Szewciw, anticoagulation clinic pharmacist at Community Hospital, says that when taken appropriately, warfarin can reduce the possibility of blood clots or resulting stroke by about 60 percent.
But “there are so many potential interactions that it can be challenging to keep patients’ medication regimens at the right levels,” adds Tsahas.
The clinics facilitate the communication necessary to prevent problems. “The pharmacist’s and patient’s communication with each other is very important. If all of a sudden eating green leafy foods (is a problem), the patient can access the pharmacy quickly, and the physicians do a wonderful job communicating with our pharmacy. We follow up with phone calls and continuously work with our patients,” says Tsahas.
Joanie Baumgartner, 71, of Lake Station, a patient at the St. Mary anticoagulation clinic for a year and half, swears by her relationship with Guerrero. “I always do a needle stick. If my (INR) number is off, Jonathan will ask me, ‘Have you been eating or drinking this or that?’” she says. “He makes adjustments to the warfarin and gets my blood to the right number. And I know I can ask him questions. He makes my appointments and orders my prescription for me — I don’t have to worry about it. He’s the best — he’s patient, he’s polite, and caring.”
“Pharmacists are in a position to serve as a gateway between patient and physician and can address issues the patients may have. That high level of care makes it easier for the patient,” says Szewciw. And the clinics’ electronic health records system makes it easier to share the information, says Clements.
“We’re capable of having a direct role, adjusting medications and more, helping patients be where they need to be in conjunction with their physicians,” Guerrero says of pharmacists, noting that gives physicians more time with patients.
Baumgartner, the St. Mary clinic patient, agrees: “Without (the pharmacist’s) help I’d be a crazy woman trying to manage my condition. We work as a team. With him and the doctor always in contact, I don’t have to worry.”