Further roll-out of the Community Pharmacy Anticoagulation Management Service
Following a successful pilot in 2010, the Community Pharmacy Anticoagulant Management (CPAM) Service was rolled out
to a further 50 pharmacies in 2013. Currently, 125 pharmacies throughout New Zealand are offering this service to over
The CPAM Service is a new model of care which involves accredited community pharmacies providing point-of-care INR testing
(by finger prick sample) and adjusting warfarin doses “on the spot” with the aid of a decision support system (INR Online).
The General Practitioner retains overall responsibility for the patient’s management and is automatically informed of
each test and the recommended dose, is consulted on tests that fall out of range, and can intervene at any time.
So far the service has been well received and has had some positive outcomes. In the latest evaluation (1 September,
2012 to 31 May, 2013) it was reported that INR test results for patients enrolled in the CPAM service were in the Therapeutic
Treatment Range (TTR) 74 – 78% of the time.1 TTR is a widely used measure of the quality of anticoagulant control. International
guidelines recommend maintaining the results in the TTR 60% of the time or more in order to maximise the benefits of warfarin
and to limit adverse effects. Studies of the usual model of care in New Zealand, where general practices arrange venous
blood sampling, testing is carried out by a community laboratory, and results are received and communicated back to the
patient, have reported TTRs less than 60%.2
Patients using the CPAM service were compliant with INR testing, with over 80% of patients getting their tests on or
before the due date.2
Patients, Pharmacists, General Practitioners and Practice Nurses were surveyed on their opinions of the CPAM service
during the pilot study and following the initial roll out. Pharmacists were overwhelmingly positive about the service
and supported its continuation. Most patients found the CPAM service convenient and accessible, and had confidence in
the pharmacist’s ability to perform the service. A small proportion of patients expressed a preference for receiving care
from their General Practitioner. Overall General Practitioners and Practice Nurses trusted the Pharmacists to provide
this service, and felt that it freed up time for them and was more convenient for their patients. Some were concerned
about communication of results and possible fragmentation of services. However, most believed the service should continue
and be more widely available.2
Pharmacies are funded through DHBs to provide this service and it is provided free of charge to the patient. General
Practitioners can work with pharmacies to identify patients suitable for the service. Some patients will still require
management by the practice and others may be referred back. Patients can opt-out of CPAM at any time.
For further information, contact a local pharmacy or general practice involved in the Community Pharmacy Warfarin Service.
A list of some pharmacies offering the CPAM service is available from:
For background information on CPAM, see: “
INR point of care testing in community pharmacies – is this the future?”,
BPJ 31 (Oct, 2010).
- CPAMS Working Group. Interim Review of the Community Pharmacy Anticoagulation (CPAM) Service. 2013.
- Shaw J, Harrison J, Harrison J. Community Pharmacist-led Anticoagulation Management Service Final Report. 2011.