Background: Despite the shift towards direct-acting anticoagulants, warfarin remains widely used in Canada and is traditionally managed by family physicians through laboratory-based international normalized ratio (INR) testing. The Community Pharmacy Anticoagulation Management Service (CPAMS) in Nova Scotia represents an innovative approach, enabling community pharmacists to conduct point-of-care (POC) INR testing and manage warfarin therapy. A potential benefit of this approach is the opportunity to identify non-warfarin medication therapy problems (nwMTPs) during routine visits. Method: We conducted a prospective, multicentre, observational study across 40 community pharmacies in Nova Scotia, part of CPAMS’s second phase. Pharmacists documented nwMTPs identified in patients with atrial fibrillation during routine POC INR visits using the Qualtrics Insight Platform, categorizing them by indication, effectiveness, safety, or adherence, alongside corresponding interventions. Results: Over 6 months, 43 nwMTPs were submitted from 13 unique pharmacies. There were 3404 POC INR tests in patients with atrial fibrillation, yielding an estimated nwMTP detection rate of 1.26 (95% CI, 0.69 to 2.32) per 100 INR tests. The most common nwMTP category was “Indication,” primarily requiring additional therapy. Pharmacists frequently intervened by recommending medication adjustments or providing patient education. Discussion: The findings highlight a modest, yet potentially significant role of pharmacists in detecting and managing diverse MTPs during focused warfarin management assessments. The predominance of indication-related problems underscores unmet therapeutic needs in patients on warfarin. Conclusion: This study illustrates the potential of pharmacist-led POC INR testing in community settings to identify and address nwMTPs, contributing to comprehensive patient care.

Jeff Nagge

Michelle Moussa

Amleset Zerai

Joey Champigny

Lisa Woodill

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Established in 1868, the Canadian Pharmacists Journal is the oldest continuously published periodical in Canada. Our mission is to enhance patient care through advancement of pharmacy practice, with continuing professional development, peer-reviewed research, and advocacy. Our vision is to become the foremost journal for pharmacy practice and research.

Established in 1868, the Canadian Pharmacists Journal is the oldest continuously published periodical in Canada. Our mission is to enhance patient care by advancing pharmacy practice through continuing professional development, peer-reviewed research, and advocacy. Our vision is to become the leading journal for pharmacy practice and research.

《Canadian Pharmacists Journal》创刊于1868年，是加拿大历史最悠久的持续出版期刊。我们的使命是通过推进药学实践来提升患者护理，提供持续的专业发展、同行评审的研究以及倡导活动。我们的愿景是成为药学实践和研究领域的首要期刊。

Medication therapy problems detected at community pharmacy INR checks

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Journal Info

Category	Quartile
PHARMACOLOGY & PHARMACY	3