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Community Pharmacy Anti-Coagulation Management Service

In December 2010 a Community Pharmacy Anti-Coagulation Management (CPAMS) Service was piloted in community pharmacies throughout New Zealand. The CPAM Service uses international normalised ratio (INR) point-of-care testing and adjusts warfarin doses with the aid of a decision support system in the pharmacy.

After a successful evaluation of the pilot by the University of Auckland it was agreed to expand the CPAM Service under the new Community Pharmacy Service Agreement.

GPs who worked with the pharmacies in the pilot project were supportive of the outcomes. Reports included more favorable outcomes for patients, with the immediacy of results leading to improved compliance. 

The CPAM Service is an integrated care model providing an excellent example of the pharmacist and GP working collaboratively for the benefit of the patient, and as integral members of the primary health care team. This greater emphasis on the multi-disciplinary health team is a key strategic goal of the new community pharmacy service model.

There are now 158 community pharmacies now providing CPAMS with over 6000 patients currently working directly with their local pharmacist to manage their warfarin levels.

DHBs are facilitating training courses to provide appropriate training for recent providers.

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Quality Report - new information on how CPAMS is being delivered

Community pharmacies providing CPAMS

Information pharmacists need to deliver CPAMS

Further reading and research for GPs and pharmacists

How are patients benefiting from CPAMS?

Quality report - new information on how CPAMS is being delivered

View the latest national CPAMS Quality Report to see how community pharmacies are delivering the Service. The Report uses INR Online (software provider) data so show quality measures of care based on:

  • The number of bleeds
  • Time in Therapeutic Range (TTR)
  • Timeliness of testing

A pharmacy specific report based on the same quality measures of care is available so you can compare and self assess your pharmacy's service delivery. This is available from DHB Portfolio Manager. 

We encourage pharmacies to keep a copy of the definitions to hand when viewing their own data and the Report. The definitions explain the method used to calculate the results and information in the Report.

If you are a General Practitioner working to support your patients manage this INR levels through their community pharmacy, the evidence in the Report may help support your clinical judgements about CPAMS and whether it is right for you and your patients.

National Quality Report July to December 2016
National Quality Report January - June 2016

Below are some frequently asked questions about the Report. 

If you are currently prescribed warfarin and are interested in learning more about the service please contact your GP.

If you are a pharmacy owner you can contact your DHB Portfolio Manager for more information.

What should you do with this data?

Pharmacy owners should use it to self assess the level of service delivery they provide and the areas that could be developed.  

Information can be shared by pharmacy with local GPs as it provides evidence to support their clinical judgments about the Service and the benefits for service users.

How often will this Report be updated?

Every six months and the latest version will be made available on this webpage.

Which community pharmacies are providing CPAMS?

Find a contracted CPAMS pharmacy

Information about delivering CPAMS

Below are a series of key documents that all CPAMS providers need to be aware of before they begin providing the service. 

Resources for pharmacists working with patients

CPAMS fact sheet for patients
Suggestions for getting started 
CPAMS fact sheet for primary & community care
Patient registration and consent form
CPAMS case studies
Letter to patients - template for pharmacists

Information to help pharmacists get started with CPAMS

Standard Operating Procedure  
Service Specifications  
GP Referral Form  
Letter to General Practice - template for pharmacists  
Invoicing and Reporting Information  
Sample invoice for use by CPAMS providers  
Standing Orders for CPAMS  
Pre-requisites for providing the Service   
Advice on INR test options for patients away from home   
CPSA 2012 - Variation for pharmacies undertaking CPAM  

Further information and reading


NZMJ - The Community pharmacy based anti-coagulation management service achieves a consistently high standard of anticoagulant care
BMJ - Anticoagulant management to assess anticoagulant control using decision support software
IJPP - CPAMS An evaluation of a collaborative model of care in NZ
IJPP - CPAMS Attitudes towards a new collaborative model of care in primary care
RNZGP article on CPAMS
Interim Review of CPAMS September 2013
CPAMS Pilot Evaluation Review - September 2011


How are patients benefiting from CPAMS?

Learn more about how patients learning to manage their INR levels and improve their overall health as a result of the support they receive from their community pharmacy as part of this service by reading the CPAMS Case Studies .

Additional CPAMS information is available for General Practitioners on the Prescriber page.