Margaret Duguid

Optimizing the Use of Antithrombotic Therapy for Atrial Fibrillation in Older People: A Pharmacist‐Led Multidisciplinary Intervention

Objectives: To develop, implement, and evaluate a pharmacist‐led multidisciplinary intervention in a hospital setting that would optimize antithrombotic use in elderly atrial fibrillation patients. The hypothesis that there would be an increase in the proportion of patients receiving antithrombotic therapy at discharge was tested.

The impact of age on antithrombotic use in elderly patients with non-valvular atrial fibrillation

Aim of study: To investigate the use of antithrombotic therapy in elderly patients with atrial fibrillation (AF). Methods: Data were collected retrospectively from the medical records of 262 AF patients >65 years, who were admitted to a Sydney teaching hospital over a 12‐month period.

Balancing risk versus benefit: the elderly patient's perspective on warfarin therapy

Warfarin therapy is underused in the target at-risk elderly population. Clinicians perceive that older patients are reluctant to use this therapy, however the perspective of patients or their carers has yet to be explored. Objective: To explore in-depth the perspectives of elderly patients and/or their carers regarding the use of warfarin therapy. Method: A qualitative study, using semi-structured group interviews was undertaken. The audio-taped discussions were transcribed verbatim, then thematically analysed to identify emergent themes. Group discussions were conducted at a major Sydney teaching hospital, over a 2-month period. Individuals aged 65 years or older (and/or their carers) who were using long-term (6 months) warfarin therapy were recruited by voluntary response to study flyers. Results: 17 patients and carers (mean age 77.2 SD=7.5 years) participated in one of two focus groups. Five core themes emerged regarding warfarin therapy: inadequate knowledge and understanding about it, patients/carers variable experience of information provision, cycle of reactions to being on it, issues in its practical management, and the spectrum of experiences with it. Overall, participants were very accepting of the therapy, describing a high level of compliance, despite initial fears and anxieties, and a relative lack of knowledge. Patients felt somewhat abandoned in their management of warfarin due to the lack of ongoing support services in the community, and inadequate information provision. Conclusions: Elderly patients and their carers appear to be quite accepting of warfarin therapy, in contrast to the perceptions of health care professionals. More effort is needed, however, in terms of information provision, particularly in the form of community-based services, to assist patients in the long-term management of warfarin.

Pharmacists and Antimicrobial Stewardship

The theme of the World Health Day 2011 declared by the World Health Organization (WHO) was combating antimicrobial resistance. The WHO called on all stakeholders - policy makers, the pharmaceutical industry, the public, patients, prescribers and pharmacists - to act and take responsibility for combating antimicrobial resistance. Worldwide there is growing concern about the emergence of antimicrobial resistance, which is described as an emerging threat to public health and a major patient safety issue. Patients with infections from resistant bacteria experience delayed recovery, treatment failure and even death. Recent studies have reported that patients with antimicrobial-resistant infections are twice as likely to die than patients with infections from non-resistant organisms. When multi-resistant pathogens are prevalent, clinicians are forced to use broad spectrum and usually more expensive antimicrobials to treat seriously ill patients. These effects contribute to increasing healthcare and societal costs.