Anticoagulation management: an interdisciplinary curriculum for family medicine residents.

Anticoagulants are high-risk medications with the potential to cause significant patient harm if inappropriately managed. Medical trainees and practicing physicians often report inadequate education and uncertainty in decision-making related to anticoagulation therapy. To address this gap, an interdisciplinary Anticoagulation Management Training Program was developed for family medicine residents at the Toronto Western Family Health Team. Evaluation data demonstrated both improved knowledge and confidence in prescribing, monitoring, and adjusting anticoagulation therapy. This suggests that similar dedicated curricula be considered in other family medicine programs in order to optimize patient safety by enhancing the knowledge and self-efficacy of future practising physicians.

Les anticoagulants sont des médicaments à haut risque qui, mal gérés, peuvent causer des dommages importants aux patients. De nombreux étudiants en médecine et médecins en exercice déclarent que leur formation est inadéquate et qu'ils ont des doutes lorsqu'ils prescrivent un traitement anticoagulant. Pour combler cette lacune, une formation interdisciplinaire en gestion des anticoagulants a été élaborée pour les résidents en médecine familiale au sein de la Toronto Western Family Health Team. Les données d'évaluation de la formation indiquent une amélioration sur le plan des connaissances et de la confiance lors de la prescription, ainsi que sur celui du suivi et de l'ajustement de l'anticoagulothérapie. Ces résultats suggèrent qu'il serait donc pertinent d'envisager l'introduction de formations spécialisées de ce type dans les programmes de médecine familiale pour mieux assurer la sécurité des patients par le développement des connaissances et de l'auto-efficacité des futurs praticiens.

Implementation of a self-administered questionnaire to identify patients at risk for medication-related problems in a family health center.

STUDY OBJECTIVE: To determine if a self-administered questionnaire can improve the identification of patients at risk for medication-related problems (MRPs) compared with usual methods of referral to a pharmacist. DESIGN: Prospective, randomized controlled study. SETTING: Multiprofessional primary care clinic at a tertiary care teaching hospital. PATIENTS: One hundred ninety-four ambulatory patients aged 18 years or older who were taking at least two drugs. MEASUREMENTS AND MAIN RESULTS: Patients completed a five-item, self-administered questionnaire modified from a tool that was previously validated in another population and statistically correlated with the risk of MRPs. Of 194 patients who completed the questionnaire, 89 were randomized to the control group (referral by usual methods) and 105 were referred according to their responses on the questionnaire (intervention group). Primary outcomes were the rate of referral and the number of at-risk patients identified. Referral rates were higher with the questionnaire than with usual methods (20% vs 6%, p=0.003). Of five patients referred by usual methods, one was at risk for MRPs according to questionnaire results. Of 84 patients in the control group who were not referred, 12 (14%) were at risk according to the questionnaire results; this finding suggested that several at-risk patients who were not referred by usual methods might have benefitted from a referral for a pharmacist's assessment. CONCLUSION: This self-administered medication risk assessment questionnaire effectively complemented the usual practices for identifying and referring patients at risk for MRPs.