Research Areas: Anticoagulation Drug Therapy

 

Members of UMORE have been involved in many community and hospital projects directed at improving the use of medications and patient outcomes. In particular, Prof Greg Peterson has been the chief researcher on many projects relating to anticoagulation. These internationally published projects have included:

		Studies of the quality of anticoagulant use ( Corbett NE, Peterson GM. Review of the initiation of anticoagulant therapy. J Clin Pharm Ther 1995; 20: 221-4)
		Interventions to improve anticoagulant usage (Peterson GM, Drake CI, Jupe DML, Vial JH, Wilkinson S. Educational campaign to improve the prevention of postoperative venous thromboembolism. J Clin Pharm Ther 1999; 24: 279-87)
		Clinical audits of the management of atrial fibrillation (Ang SY, Peterson GM, Friesen WT, Vial JH. Review of antithrombotic drug usage in atrial fibrillation. J Clin Pharm Ther 1998; 23: 97-106; and Jackson SL, Peterson GM, Vial JH, Daud R, Ang SY. Outcomes in the management of atrial fibrillation: clinical trial results can apply in practice. Internal Med J 2001; 31: 329-36)
		Laboratory-based research to investigate approaches to initiating warfarin therapy (Peterson GM, McLean S, Jupe DML, Griffith RL, Roberts JR. A model which predicts maintenance warfarin dosage requirements from the response to a single dose. Br J Clin Pharmacol 1985; 20: 177-8; and Jupe DML, Peterson GM, Coleman RL, McLean S. Warfarin dosage requirements: prospective clinical trial of a method for prediction from the response to a single dose. Br J Clin Pharmacol 1988; 25: 607-10)
		Improving the prescribing of antithrombotics for stroke prevention in AF in the community setting through academic detailing and education of doctors (Jackson SL, Peterson GM, Vial JH. A community-based educational intervention to improve antithrombotic drug use in atrial fibrillation. Ann Pharmacother 2004; 38: 1794-9)
		The role and outcomes of an anticoagulation pharmacist position in the hospital setting (present project)
		Improving prophylaxis of venothromboembolism in medical patients (present project)

The UMORE research group also has the most experience in Australia with portable International Normalised Ratio (INR) monitoring for patients receiving the number one drug for adverse patient outcomes, warfarin. Several projects recently completed or near to completion are:

		An evaluation of the accuracy and reproducibility of the CoaguChek portable INR monitor (Jackson SL, Bereznicki LR, Peterson GM, Marsden KA, Jupe DM, Tegg E, et al. Accuracy, reproducibility and clinical utility of the CoaguChek S portable international normalized ratio monitor in an outpatient anticoagulation clinic. Clin Lab Haematol 2004; 26: 49-55)
		An evaluation of near-patient INR monitoring by rural general practitioners around Australia (Jackson SL, Bereznicki LR, Peterson GM, Marsden KA, Jupe ML, Vial JH, Rasiah RL, Misan G, Williams SM. Accuracy and clinical usefulness of the near-patient testing CoaguChek S INR monitor in rural medical practice. Aust J Rural Health 2004; 12: 137-42)
		Improving the management of anticoagulation: A randomised controlled trial of point of care home follow-up of warfarin therapy after initiation in hospital (Jackson SL, Peterson GM, Vial JH, Jupe DML. Improving the outcomes of anticoagulation: an evaluation of home follow-up of warfarin initiation. J Intern Med 2004; 256: 137-44; and Jackson SL, Peterson GM, Vial JH, Jupe DML. Suboptimal anticoagulant management in patients after hospital initiation of warfarin. Aust Fam Physician 2004; 33: 477-8)
		Improving the outcomes of anticoagulation in rural Australia : an evaluation of pharmacist-assisted monitoring of warfarin therapy (Jackson SL, Peterson GM, House M, Bartlett T. Point-of-care monitoring of anticoagulant therapy by rural community pharmacists: description of successful outcomes. Aust J Rural Health 2004; 12: 197-200; and Jackson SL, Peterson GM, Bereznicki LR, Misan G, Vial JH, Jupe DML. Accuracy, clinical usefulness and perceptions of community pharmacy-based INR monitoring in rural Australia . J Clin Pharm Therapeutics 2005; 30: 345-353

UMORE has undertaken several projects investigating patient self-monitoring of the INR and self-management of warfarin therapy – the first studies of this type in Australasia . The development and evaluation of ICT solutions are incorporated into these projects. The group is currently implementing a project that will facilitate point-of-care monitoring of INR values in the Aged Care Setting, incorporating bi-directional point-to-point electronic communication with general practitioners.

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