Evaluation of an alternative model of anticoagulant care

Alternative models for the delivery of anticoagulant care are required in view of an estimated increase of 20% per annum in patients requiring treatment, and an inability for the present service to deal with this increase. This led to a restructuring of the anticoagulant service, which included the appointment of a nurse specialist and the implementation of a computer-assisted warfarin dosing system.

To assess the impact of changes in the delivery of anticoagulant care in one unit.

A previous consultant-led delivery service of anticoagulant care was compared with the current nurse-led service. Two six month periods was compared. The end points of the study were INR control, appointment intervals and clinic size. A patient questionnaire was completed to assess patient satisfaction and education.

In two years, attendance at walk-in clinics increased by 43% but the number attending anticoagulant clinics decreased by 50%. There was a parallel increase in the number of patients presenting on a flexible 'walk-in' basis for phlebotomy with postal dosing with 76% of patients now being managed on a flexible postal system. Anticoagulant control and reattendance intervals compare favourably, the percentage of patients attending at the maximal reattendance interval of eight weeks has increased from 3% to 15%. Patient knowledge and satisfaction scores were high on the questionnaire. Financially, this model of care is more cost effective than employing further doctors.

The introduction of a nurse specialist managed service has allowed us to accommodate a 21% annual increase in patient numbers while improving the overall quality, efficiency and cost-effectiveness of the service and patient care.