Patients on oral anticoagulation therapy (OAC) will receive a pharmacists led medication review with a focus on anticoagulation therapy (extended polymedication check)

Behavioral: Medication review

Patients on oral anticoagulants and polypharmacy will receive extended polymedication check to identify Pharmaceutical Care Issues, Adherence Issues, Drug related problems and Knowledge Gaps

The PMC has been implemented in 2010 as a new cognitive service provided by any community pharmacist to patient with polypharmacy (n>3 drugs) on long term conditions (> 3 months) and is reimbursed by swiss health insurance. The semi-structured interview contains questions about knowledge on oral anticoagulation therapy. This extended PMC follows a structured predefined protocol.

As an outcome, pharmacist may install a compliance support e.g. weekly filled pill organizer.

Knowledge about oral anticoagulation therapy will be assessed during the extended Polymedication check which includes 8 specific questions on oral anticoagulation knowledge. After 2 Weeks a follow-up telephone interview will be performed and the same 8 questions will be assessed.

Medication history from pharmacy software will be used to calculate the MPR of all drugs, retrospectively starting 12 months before the extended PMC takes place.