Alternative models of delivery of anticoagulant services

The dramatic increase in patients on oral anticoagulants in the last decade has led to the development of alternative models of anticoagulant care delivery. Some degree of decentralization is desirable to maintain the efficiency and quality of the anticoagulant control service. One effective model, which has relatively few resource implications, is the decentralized system whereby patients have blood drawn in the general practice premises but analysis and dosing is still performed by the hematology department, a model that provides increased efficiency while maintaining the standards of clinical care. The use of computerized decision support systems has been central to the decentralization process and has led to improvements in quality of service in hospitals and the primary-care setting. Regardless of the model adopted, it is important to follow clinical guidelines, take part in external quality-control, and perform regular audits to assess the delivery of the service.