Health care legislation recently passed in Quebec gives new authority to pharmacists and opens the door to new opportunities in patient care. The bill, called Bill 90, gives pharmacists the authority to adjust medication doses on the basis of test results. For some patients, this will mean less time commuting to and from their doctor. This is especially good news for people taking medications that require close monitoring, such as anticoagulants like warfarin (Coumadin®).
If you are currently taking warfarin, your doctor has probably told you that you will need to closely monitor your INR (International Normalized Ratio) on a regular basis. For many Canadians who use these medications, this means regular trips to the lab for blood tests, often including a wait for blood test results, possibly followed by trips or calls to the doctor's office for medication adjustments. Testing is important because it ensures that your blood is clotting neither too quickly, which raises your risk of clots, nor too slowly, which increases your risk of bleeding. If your INR falls out of a target range set by your doctor, the dosage of anticoagulation medication you are prescribed is adjusted so that the INR will return to the target range in order to reduce the risk of complications related to the medication.
Over 100,000 people in the province of Quebec use anticoagulation medications. And, until recently, like other Canadians who are prescribed this treatment, they had to be professionally monitored on a regular basis, along with the regular inconvenience that entailed. With the new legislation in place, Quebecers will be able to monitor their own INR and get their treatment adjusted by the pharmacist where necessary, without delay or inconvenience. Pharmacists will play a major role in improving a person's quality of life through their ability to monitor patients and decrease the waiting time in laboratories or doctor's offices.
In Quebec, the first step is that the patient needs to get a prescription from a doctor for a self-testing coagulation monitor. Once a patient receives this prescription, they are educated by a specially-trained pharmacist on how to use the monitor and the test strip. They also receive follow-up by the pharmacist to ensure that they continue to perform the monitoring correctly. The patient can either do self-testing at home or have it done in pharmacy.
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