Multi-disciplinary care in action—The physician-pharmacist rapid access atrial fibrillation clinic.

Abstract

Background: Atrial fibrillation (AF) is a cardiac condition where time to assessment and treatment is critical for reducing stroke risk. However, Australian data has shown low uptake of appropriate anticoagulation and increasing hospitalisations for AF. Regional healthcare systems have been shown to be at greater risk of these adverse events. To address this, a physician-pharmacist model of care was developed and implemented in a regional centre of Victoria. Methods: The rapid access atrial fibrillation (RAAF) clinic involved telehealth pharmacist appointments complimented with a physician’s consult and aimed to see patients within 14 days of referral. A mixed-methods approach was used to understand how this service modified access to care, managed risk of stroke, impacted patient experience, and impacted hospital presentations. Results: There were 312 patients referred to the service over 2022–2023, 274 patients were consulted over 268 pharmacist and 421 physician appointments. Median days from referral to clinic were 14(IQR 9–20), compared with 224(47–284) for general cardiology. Appropriate anticoagulation for patients at risk of stroke increased from 88% pre-clinic to 97% post-clinic. Patients were accepting of the RAAF clinic, with 74.4% of patients rating their experience above eight out of 10. Unplanned admission rates at 30 days post clinic were 7.7% for those referred from hospital wards, compared to the state average for that time period of 14.6%. Conclusion: A RAAF clinic using a physician-pharmacist model of care was successfully implemented in a regional health setting, leading to improved access and anticoagulation management, with high levels of patient acceptance.