title: Reorganization of oral anticoagulant (warfarin) treatment follow-up.
abstract: OBJECTIVE
  To evaluate the impact of the reorganization of oral AC treatment management in a primary healthcare setting in terms of quality of care and cost of care. The evaluated reorganization involved the adoption of an AC nurse service model supported by the use of information and communication technology for storing and handling follow-up data.
  
  
  METHODS
  Statistical analysis of AC follow-up data, personnel task distribution and resource use analysis, and survey of personnel experiences.
  
  
  METHODS
  The Paloheinä health station in Helsinki, Finland.
  
  
  METHODS
  All 122 Paloheinä patients on oral AC treatment and the related Paloheinä personnel. Also, follow-ups from two comparison health stations from Helsinki were used.
  
  
  METHODS
  Laboratory P-INR and follow-up density distributions before and after follow-up reorganization for Paloheinä and comparison station patients, task distribution, and personnel resource use in treatment guideline assignment before and after reorganization and gathered personnel experiences.
  
  
  RESULTS
  No statistically significant changes (Pearson's chi-square test, p < 0.05) were observed in P-INR distributions, considering also the comparison stations. Adoption of the AC nurse model resulted in a 66%/34% task distribution between nurses and physicians in guideline assignment. Personnel resource use analysis showed a cost decrease of 1.61 euros per follow-up in guideline assignment. Users who responded to the survey were generally satisfied with the reorganization and its subjective impacts.
  
  
  CONCLUSIONS
  Reorganization resulted in a potential reduction in cost of care per follow-up without a change in the observed quality of care in the Paloheinä setting. Personnel generally accepted the reorganization.
authors.affiliation: Terivan Oy, Tampere, Finland. samuli.niiranen@terivan.com
authors.forename: Samuli
authors.initials: S
authors.lastname: Niiranen
authors.forename: Ulla
authors.initials: U
authors.lastname: Wartiovaara-Kautto
authors.forename: Martti
authors.initials: M
authors.lastname: Syrjälä
authors.forename: Raija
authors.initials: R
authors.lastname: Puustinen
authors.forename: Jari
authors.initials: J
authors.lastname: Yli-Hietanen
authors.forename: Heikki
authors.initials: H
authors.lastname: Mattila
authors.forename: Seppo
authors.initials: S
authors.lastname: Kalli
authors.forename: Heikki
authors.initials: H
authors.lastname: Lamminen
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000097:blood; D003151:Community Health Centers / Q000191:economics / Q000458:organization & administration / Q000592:standards; D017046:Cost Savings; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D019934:International Normalized Ratio; D016347:Medical Records Systems, Computerized; D009726:Nurses; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014859:Warfarin / Q000008:administration & dosage* / Q000097:blood; D000078329:Workforce
chemical_list: D000925:Anticoagulants; D014859:Warfarin