Exploring the pharmacists' role in the efficacy and safety of antithrombotic therapy
Authors: Van Paassen JG , Deneer VHM , Bouvy ML 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
In recent guidelines of atrial fibrillation (AF) and acute coronary syndromes (ACS) the ESC emphasizes the role of the pharmacist in the multidisciplinary team to support patient-centred care.
Dispensing antithrombotics for AF and ACS patients is a daily task for the pharmacist. This antithrombotic therapy is a challenge for all healthcare professionals due to the delicate balance between efficacy and safety. To date the perceptions of the Dutch community pharmacists on this specific multidisciplinary role in antithrombotic therapy is not known.

Purpose
In this study we explored the pharmacists’ perspectives on their role in antithrombotic therapy in a multidisciplinary setting.

Methods
We conducted a qualitative study, using semi-structured interviews with Dutch community pharmacists. The interviews were assumed to take 45-60 minutes each and were executed using Microsoft Teams. The Theoretical Domains Framework (TDF) was the scientific basis for the interview protocol and subsequent analysis. A purposive sample of pharmacists from the Utrecht Pharmacy Practice network for Education and Research (UPPER) was approached, aiming at diversity in (a) region, (b) independent and part of a pharmacy chain and (c) stand-alone pharmacy or part of a health centre.

Results
A total of 203 pharmacists were approached by email of whom 16 agreed to the interview. The pharmacies were located in 11 of 12 provinces of the Netherlands. The interviews were conducted from March to August 2021 and had a mean length of 56 minutes (range: 39-66 min).
Half of the pharmacists was working for a pharmacy chain and 75% of the pharmacies were located in a health centre. Data saturation was reached after 13 interviews. During the 3 subsequent interviews no new themes emerged.
The pharmacists interviewed felt responsible for the treatment outcome of their patients. They intend to invest in their role in antithrombotic therapy, with patient-centred care as their motivator. Extensive insight into patient information and medication, such as the original indication, reasons to deviate from guidelines and relevant laboratory values, would strengthen their role as pharmaceutical experts. A fruitful relationship with other healthcare professionals improved the multidisciplinary collaboration and involvement. The level of knowledge of antithrombotic therapy differed among the interviewees.

Conclusion
This study shows that the interviewed Dutch community pharmacists perceive a role for themselves in antithrombotic therapy as healthcare professionals in primary care, in conjunction with medical specialists and general practitioners, as stated in the ESC guidelines. To optimise multidisciplinary collaboration, the pharmacists should extend their knowledge on antithrombotic therapy and invest in the relationship with other healthcare professionals. Extensive insight into patient information and medication would further benefit the treatment outcome.