Blood clots can lead to a number of severe health complications, including death in extreme cases.
Approximately 500 blood clots in the veins will occur annually in Newfoundland and Labrador. But the recent evolution of thrombosis care services in the province aims to reduce that number.
Thrombosis care has existed within Eastern Health for years.
A new and re-imagined thrombosis clinic at the Health Sciences Centre in St. John’s is continuing to provide thrombosis care but is doing so in a more efficient way for both patients and the health-care system, combining the full spectrum of care a patient needs.
“[Dr. Stephanie Young] took all of the pieces I had in my head, put them to paper, and we began the process.”
Dedication, inspiration and a sense of destiny helped Dr. Rufaro Chitsike’s vision of a thrombosis clinic to become a reality when he connected with Dr. Stephanie Young, School of Pharmacy. Dr. Rufaro Chitsike is an assistant professor of hematology in the Faculty of Medicine.
“I came to Newfoundland and Labrador in January of 2012, and the first meeting of the Eastern Health anticoagulation committee met a couple of months after that. Stephanie was chairing that committee and afterwards, I thought, ‘Where have you been all my life?’” laughed Dr. Chitsike.
“We went to the cafeteria after that meeting and I realized that she’d been envisioning the same type of service as I had, and from there, she took all of the pieces I had in my head, put them to paper, and we began the process of drafting a funding proposal for the service.”
One umbrella
The service includes an emergency thrombosis clinic for care after a blood clot diagnosis, several types of followup clinics depending on the type of medication the patient is receiving and the needs of the patient, and a clinic to develop a management plan for anticoagulation medication, if surgery or a procedure is required.
Dr. Young says combining the services improves care for a number of reasons.
“Patients receive faster access to specialty care, meaning there are reduced wait times and they receive more thorough care while they’re being seen, which translates to more efficiencies both for the patient and for the health-care system,” she said.
“With the previous service, a patient would have symptoms, then go to the emergency room, be diagnosed with a blood clot, be given a medication and told to go back and consult with their treating physician and continue the medication without a specialty followup consultation booked,” Dr. Young continued. “If any complications were to occur, they would have to be referred back to a specialist, which could take another six months.”
Modelled on existing thrombosis centres of excellence in Montreal, Toronto and Ottawa — a patient receives an emergency room diagnosis and then goes directly to the thrombosis clinic — Eastern Health’s service is keeping pace with the rest of Canada.
Interdisciplinary team
Care at the thrombosis clinic is provided by a team of clinical pharmacists and hematologists, as well as managers from the Medicine Program within Eastern Health, who have been instrumental in implementing the program.
In addition to Eastern Health’s Departments of Pharmacy and Hematology, assistance has come from a number of other departments and committees, including Laboratory Services.
Dr. Chitsike says the administrative staff at Eastern Health have also been dedicated to the final phases of the project’s implementation.
“With this change, clients can access services at the right time and in the right place.”
According to Jeannine Herritt, program manager, Regional Medicine Program, the project aligns with Eastern Health’s strategic priorities for 2017-20 and is an example of the program’s commitment to the provision of quality health care.
“With the implementation of the thrombosis service, the spectrum of care has expanded,” she said.
“With this change, clients can access services at the right time and in the right place — improving efficiency for both the patient and the health-care system.”
The program is also taking advantage of the skills and knowledge of the participating pharmacists, including administering injections and more hands-on patient assessment.
Ongoing evaluation
Within the thrombosis clinic, Drs. Young and Chitsike are overseeing a team of Memorial University researchers who are working with Eastern Health on a three-year project to evaluate the service.
The evaluation will include the effect on patient care and an economic evaluation. Dr. Hai Nguyen, a health economist in the School of Pharmacy, as well as a post-doctoral fellow, also in the School of Pharmacy, complete the research team.
Both Drs. Chitsike and Young are thankful for the “dream team” involved and are optimistic about how the service will continue to grow.
“We’re drawing on the team’s experience in both medicine and pharmacy, to provide service and conduct research to provide better care for the future,” said Dr. Chitsike.
