1. Establishment of An Economically Viable Comprehensive Multidisciplinary Anticoagulation Program In An Academic-Based Residency Lilika White MD, Andrew Hwang PharmD, George Samraj, MD University of Florida CHFM, Gainesville, FL

2. Disclosures None

3. Introduction  Family medicine is the accepted primary care specialty with a wide scope of practice including anticoagulation management.  U.S. population aging, conditions requiring the use of long- term anticoagulation such as atrial fibrillation are expected to increase.  Warfarin is a common anticoagulation medication requiring continuous monitoring and education.  It has been proven that rates of therapeutic ranges appear to improve significantly under the care of comprehensive anti-coagulation clinics.  Established comprehensive anticoagulation clinics are known to improve patient outcome.

4. University of Florida Family Medicine Residency Program Anticoagulation Clinic Gainesville, FL  Residency program was started in 1973.  The program is located in a university town with a tertiary care hospital  >250 graduates from the program.  10 residents per class.  Based out of a Primary Care Clinic where residents and Attending physicians see their continuity patients.  Also home to multidisciplinary Coumadin clinic.  Patients seen are patients of residents and Attending physicians  Other satellite Family Medicine clinics in the city.

5. Anticoagulation Clinic  Coumadin clinic established in >25 years ago and currently sees approximately 50+ patients per week  Previous Model: Pharmacy students, supervised by pharmacy fellow (who was supervised by Pharmacy faculty), and Family Medicine precepting faculty – Level 0  New Model: In 2014 Main St. Coumadin clinic took on a multidisciplinary approach including:  Family Medicine residents  Pharmacy Fellow  Pharmacy students  Medical students  Level 3

6. Old Clinic Model – Level 0  Appointment/Front office  POCT INR  Pharmacy student evaluation  Pharmacy Fellow (experience)  FM Faculty Preceptor  Pharmacy Student  Billed as Level 0 visit (Pharmacy visit)

7. Improved Clinic Flow – New model Appointment/Front office Level - III Discussed with FM Resident and Student Patient Evaluated FM resident/pharm st Discuss management w/ patient Precept with FM Faculty POCT INR Pharmacy student evaluation

8. PHARMACY STUDENT EVALUATION

9. Other models of Anticoagulating clinics  Pharmacist only  Pharmacist with pharmacy students  Pharmacist, Nurse, MA (telephone care)  Nurse/ Nurse Practitioner  Physician  Family Medicine Residency Staff

10. Innovative Economically viable Educational model of anticoagulation clinic  Previous model Level 0 service without residents involvement  New innovative multidisciplinary model integrating residents  Level 3 service

11. Benefits of the Program  Patient care, education  Pharmacy student education  Family medicine resident education  Medical student education  Improved revenue to sustain the program  Level 4  Increase in resident’s numbers of patient contacts  Multidisciplinary involvement and care coordination with other specialties including Cardiology and Hematology

12. Limitations  Not applicable in all clinics  Pharmacist/students  Residents/schedule  Available patient rooms  Not applicable in community-based programs  Pharmacy students/fellow

13. Work in progress  Our model may be beneficial in improving the learning experience and providing adequate tools to face the future challenges of comprehensive family medicine.

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