Impact of health disparities on staff workload in pharmacist-managed anticoagulation clinics

Pharmacists' provision of services unrelated to anticoagulant therapy at an anticoagulation clinic in an area of prevalent health disparities (health status differences between minority and nonminority populations) was evaluated. A prospective cohort study was conducted to compare the frequency and types of additional services (i.e., services unrelated to anticoagulation) provided by pharmacists during an eight-week period at an urban clinic serving a primarily minority and socioeconomically disadvantaged patient population (clinic A) and a suburban clinic serving a primarily nonminority and affluent population (clinic B). Over the study period, additional services were provided during 42% of all patient visits (n = 444) at clinic A and 8% of all visits (n = 443) at clinic B. The most commonly provided additional services involved nonanticoagulation-related medical problems, which were addressed during about 9% of visits at clinic A and 3% of visits at clinic B; other additional services included setting up appointments, arranging transportation, and providing refills of nonanticoagulant medications. Missed appointments, early or late arrivals, and walk-in appointments were much more common at clinic A. The average daily pharmacist-staffing requirement was 3.8 hours higher at clinic A; over the entire study period, clinic A required a total of about 60 more staffed hours than clinic B. Pharmacists practicing in an anticoagulation clinic serving an area of prevalent health disparities frequently spent a substantial amount of time addressing medical problems and administrative tasks unrelated to anticoagulation therapy.