1. 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

2. 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.

3. 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.

4. 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

5. 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)

6. 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

7. PHARMACY STUDENT EVALUATION

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

9. 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

10. 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

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

12. 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.