Lilika White MD, Andrew Hwang PharmD, George Samraj, MD Establishment of Economically Viable Comprehensive Multidisciplinary Anticoagulation Program In An Academic-Based Residency Lilika White MD, Andrew Hwang PharmD, George Samraj, MD University of Florida, Gainesville, FL

Introduction Family medicine is the accepted primary care specialty with a wide scope of practice including anticoagulation management. U.S. population aging, conditions requiring the use of long- term anticoagulation such as atrial fibrillation are expected to increase. Warfarin is a common anticoagulation medication requiring continuous monitoring and education. It has been proven that rates of therapeutic ranges appear to improve significantly under the care of comprehensive anti-coagulation clinics. Established comprehensive anticoagulation clinics are known to improve patient outcome.

University of Florida Family Medicine Residency Program Anticoagulation Clinic Gainesville, FL Residency program was started in 1973. The program is located in a university town with a tertiary care hospital >250 graduates from the program. 10 residents per class. Based out of Primary Care Clinic where residents and Attending physicians see their continuity patients. Also home to multidisciplinary Coumadin clinic. Patients seen are patients of residents and Attending physicians Other satellite Family Medicine clinics in the city.

Anticoagulation Clinic Coumadin clinic established in >25 years ago and currently sees approximately 50+ patients per week Previous Model: Pharmacy students, supervised by pharmacy fellow (who was supervised by Pharmacy faculty), and Family Medicine precepting faculty – Level 0 New Model: In 2014 Main St. Coumadin clinic took on a multidisciplinary approach including: Family Medicine residents Pharmacy Fellow Pharmacy students Medical students Level 3 Patients are referred to the clinic by outside providers, social workers in the hospital setting, and in house main street providers

Old Clinic Model – Level 0 Appointment/Front office Pharmacy student evaluation POCT INR Pharmacy Fellow FM Faculty Preceptor Pharmacy Student Billed as Level 0 visit (Pharmacy visit)

Improved Clinic Flow – New model Appointment/Front office Pharmacy student/fellow POCT INR Discussed with FM resident and Student Pt Evaluated Precept with FM faculty FM resident/pharm St Discuss management w/ patient Level - III

PHARMACY STUDENT EVALUATION

Other models of Anticoagulating clinics Pharmacist only Pharmacist with pharmacy students Nurse/ Nurse Practitioner Physician Family Medicine Residency Staff

Previous model Level 0 service without residents involvement Innovative Economically viable Educational model of anticoagulation clinic Previous model Level 0 service without residents involvement New innovative multidisciplinary model integrating residency Level 3 service

Benefits of the Program Patient care, education Pharmacy student education Family medicine resident education Medical student education Improved revenue to sustain the program Additional experience for the residents in managing anticoagulation Multidisciplinary involvement and care coordination with other specialties including Cardiology and Hematology

Limitations Not applicable in all clinics Pharmacist/students Residents/schedule Not applicable in community based programs Pharmacy students/fellow

Work in progress Our model may be beneficial in improving the learning experience and providing adequate tools to face the future challenges of comprehensive family medicine.