title: Evaluation of an alternative model of anticoagulant care.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To assess the impact of changes in the delivery of anticoagulant care in one unit.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Haematology, Northwick Park Hospital, Harrow, Middlesex.
authors.forename: B J
authors.initials: BJ
authors.lastname: Hennessy
authors.forename: M
authors.initials: M
authors.lastname: Vyas
authors.forename: B
authors.initials: B
authors.lastname: Duncan
authors.forename: S A
authors.initials: SA
authors.lastname: Allard
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D004739:England; D005069:Evaluation Studies as Topic; D006754:Hospital Restructuring; D006801:Humans; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D008875:Middle Aged; D017146:Models, Organizational; D009726:Nurses; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin