{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T03:42:01Z","timestamp":1781322121667,"version":"3.54.1"},"reference-count":15,"publisher":"University of Toronto Press Inc. (UTPress)","issue":"2","license":[{"start":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T00:00:00Z","timestamp":1733270400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T00:00:00Z","timestamp":1733270400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Pharmacy Association of Nova Scotia"},{"DOI":"10.13039\/100016545","name":"Roche Diagnostics","doi-asserted-by":"publisher","award":["Equipment\/in-kind support"],"award-info":[{"award-number":["Equipment\/in-kind support"]}],"id":[{"id":"10.13039\/100016545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can Pharm J"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>We conducted a prospective, multicentre, observational study across 40 community pharmacies in Nova Scotia, part of CPAMS\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Over 6\u2009months, 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 \u201cIndication,\u201d primarily requiring additional therapy. Pharmacists frequently intervened by recommending medication adjustments or providing patient education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study illustrates the potential of pharmacist-led POC INR testing in community settings to identify and address nwMTPs, contributing to comprehensive patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17151635241291854","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T05:58:36Z","timestamp":1733291916000},"page":"83-89","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Medication therapy problems detected at community pharmacy INR checks"],"prefix":"10.3138","volume":"158","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8954-1169","authenticated-orcid":false,"given":"Jeff","family":"Nagge","sequence":"first","affiliation":[{"name":"School of Pharmacy, University of Waterloo, Kitchener, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Moussa","sequence":"additional","affiliation":[{"name":"Faculty of Science, University of Waterloo, Waterloo, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6590-8004","authenticated-orcid":false,"given":"Amleset","family":"Zerai","sequence":"additional","affiliation":[{"name":"Shopper\u2019s Drug Mart, Kitchener, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9567-5598","authenticated-orcid":false,"given":"Joey","family":"Champigny","sequence":"additional","affiliation":[{"name":"Centre for Family Medicine Family Health Team, Kitchener, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Woodill","sequence":"additional","affiliation":[{"name":"Pharmacy Association of Nova Scotia, Halifax, Nova Scotia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1696","published-online":{"date-parts":[[2024,12,4]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.12927\/hcpol.2017.25321"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/17151635241228228"},{"key":"e_1_3_2_4_2","unstructured":"Point-of-Care Testing of International Normalized Ratio for Patients on Oral Anticoagulant Therapy: Systematic Review and Economic Analysis [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014. (CADTH Optimal Use Report No. 3.1B.) Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK361419\/ (accessed Oct. 21 2024)."},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijpp.12148"},{"issue":"4","key":"e_1_3_2_6_2","first-page":"293","article-title":"Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: a randomized controlled trial [published correction appears in CMAJ. 2004 Feb 17;170(4):451]","volume":"169","author":"Wilson SJ","year":"2003","unstructured":"Wilson SJ, Wells PS, Kovacs MJ, et al. Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: a randomized controlled trial [published correction appears in CMAJ. 2004 Feb 17;170(4):451]. CMAJ 2003;169(4):293-298.","journal-title":"CMAJ"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2012.07.078"},{"issue":"10","key":"e_1_3_2_8_2","article-title":"Time in therapeutic range: warfarin anticoagulation for atrial fibrillation in a community-based practice","volume":"63","author":"Gateman D","year":"2017","unstructured":"Gateman D, Trojnar ME, Agarwal G. Time in therapeutic range: warfarin anticoagulation for atrial fibrillation in a community-based practice. Can Fam Physician 2017;63(10):e425-e431.","journal-title":"Can Fam Physician"},{"issue":"6","key":"e_1_3_2_9_2","first-page":"416","article-title":"Quality of warfarin management in primary care: determining the stability of international normalized ratios using a nationally representative prospective cohort","volume":"65","author":"Liu S","year":"2019","unstructured":"Liu S, Singer A, McAlister FA, et al. Quality of warfarin management in primary care: determining the stability of international normalized ratios using a nationally representative prospective cohort. Can Fam Physician 2019;65(6):416-425.","journal-title":"Can Fam Physician"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.26910"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1502"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/106002809002401114"},{"key":"e_1_3_2_13_2","unstructured":"Pharmacy Association of Nova Scotia. Final evaluation of the community pharmacist-led anticoagulation management service (CPAMS) Canada project. 2019. Available: https:\/\/pans.ns.ca\/sites\/default\/files\/final_evaluation_report_final_-_pans_cpams_eval_2019.09.25.pdf (accessed Apr. 11 2024)."},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.4212\/cjhp.v74i1.3035"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/8755122519883642"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.4321\/s1886-36552007000200002"}],"updated-by":[{"DOI":"10.1177\/17151635251338112","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T00:00:00Z","timestamp":1745107200000}}],"container-title":["Canadian Pharmacists Journal \/ Revue des Pharmaciens du Canada"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17151635241291854","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17151635241291854","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17151635241291854","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T22:05:02Z","timestamp":1772834702000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17151635241291854"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,4]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1177\/17151635241291854"],"URL":"https:\/\/doi.org\/10.1177\/17151635241291854","relation":{},"ISSN":["1715-1635","1913-701X"],"issn-type":[{"value":"1715-1635","type":"print"},{"value":"1913-701X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,4]]}}}