Cone Health
Greensboro, NC
Outpatient management of venous thromboembolism, though recommended by current clinical practice guidelines, is underutilized, often due to fragmented care models and medication access barriers. To address this gap, our health system implemented a pharmacist-led outpatient Deep Vein Thrombosis (DVT) Clinic in partnership with vascular surgeons designed to standardize treatment, provide immediate access to medication management services and vascular surgery evaluation, and reduce emergency department (ED) and inpatient utilization for DVT management.
The DVT Clinic was created using an interdisciplinary approach led by a clinical pharmacist who established a collaborative practice agreement with a group of vascular surgeons. The clinic centralized imaging, diagnosis, anticoagulant initiation, and pharmacy services into a single outpatient location and receives referrals from throughout the health system, which spans five counties and over 150 care locations. Patients diagnosed with acute DVT on vascular ultrasound are rapidly triaged, and patients appropriate for outpatient management are immediately seen in the DVT Clinic. A protocol was established to guide appropriate referrals, distinguishing patients needing management solely by a pharmacist for medication therapy from those who may also need vascular intervention and coordinated care with a surgeon and pharmacist. Pharmacist responsibilities include anticoagulant prescribing, laboratory monitoring, medication access coordination, patient counseling, and follow-up planning. All patients leave the visit with medication in hand from the on-site, health system-owned community pharmacy.
During the first year the clinic was open (2024), the pharmacist saw 205 patients across 363 visits. More than half of initial encounters represented same-day clinic appointments that avoided the ED. Compared to 2023 baseline data, the proportion of systemwide DVT encounters occurring in the ED in 2024 decreased from 88.6% to 53.3% (p<0.001), while inpatient admissions for DVT decreased from 25.5% to 13.9% (p<0.001). Stratified analysis of 2024 data demonstrated significantly lower acute care utilization for DVT among patients managed in the DVT Clinic compared with those not seen, including emergency department encounters (15.2% vs. 91.5%, p<0.001) and inpatient admissions (1.8% vs. 26%; p<0.001). Medication access was optimized through pharmacist intervention, saving patients an average of $250 for the first three months of treatment and achieving 96% medication adherence indicated by proportion of days covered.
The pharmacist-led DVT Clinic represents a transformative advancement in pharmacy practice, redefining the role of pharmacists in ambulatory care and establishing a replicable model to optimize value-based care that shifts treatment for appropriate populations from acute to outpatient management. The clinic has demonstrated substantial clinical, financial, and operational benefits, highlighting how pharmacists can lead systemwide interprofessional initiatives that enhance quality, access, and affordability of care.
Front Row (l-r): V. Wells Brabham, Madison Yates
Back Row (l-r): Katie Sfirlea, Molly Schneider, Nicholas Gazda