title: Reorganisation of an anticoagulation clinic using a telemedicine system: description of the model and preliminary results.
abstract: OBJECTIVE
  Over the last decade, the indications for oral anticoagulant therapy have been expanded considerably, resulting in a significant increase in the number of patients followed at an anticoagulation clinic (AC). Some organisational problems, in particular related to the healthcare staff and patients, have led to the need for decentralising the healthcare activity using a telemedicine system. The aim of our project was (1) to reduce by 30% over a period of 3 years the number of patients who attend daily the AC, (2) to maintain the same quality levels defined as time spent in the therapeutic range and number of complications; and (3) to assess patient satisfaction through an open questionnaire.
  
  
  METHODS
  A net supported program (TaoNet) was installed at the AC to collect and analyse patient clinical data, connected with the peripheral health units, where clinical data and prothrombin time (expressed as international normalised ratio), reported on portable monitors (Coagucheck), are obtained and sent in real time to the AC. After clinical validation, in a few minutes the AC sends the appropriate dose adjustment as well as clinical advice to the peripheral health units.
  
  
  RESULTS
  The project was launched in January 2002. Six peripheral health units are available at present to the public, managing 404 out of a total of 2313 patients (18.3%) under treatment. An increase in the time spent in the therapeutic range was observed compared with the previous 6 months (AC = 62%, peripheral health units = 70%; p < 0.05). No differences in major complications were observed. Patients expressed their overall satisfaction, as evaluated through an open questionnaire. CONCLUSIONS. This new organisation provides the following advantages: (1) direct communication between the peripheral health units and the AC; (2) an improvement in the time spent in the therapeutic range; (3) an improvement in patient satisfaction and quality of life; (4) continuing patient record update; and (5) time gained by the healthcare staff.
authors.affiliation: Haemostasis and Thrombosis Centre, Istituti Ospitalieri Hospital, Cremona, Italy. sotesta@tin.it
authors.forename: Sophie
authors.initials: S
authors.lastname: Testa
authors.forename: Adriano
authors.initials: A
authors.lastname: Alatri
authors.forename: Oriana
authors.initials: O
authors.lastname: Paoletti
authors.forename: Giampietro
authors.initials: G
authors.lastname: Morstabilini
authors.forename: Maria Anunzia
authors.initials: MA
authors.lastname: Medagliani
authors.forename: Nadia
authors.initials: N
authors.lastname: Denti
authors.forename: Emanuela
authors.initials: E
authors.lastname: Martellenghi
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D017060:Patient Satisfaction; D011517:Prothrombin Time; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017216:Telemedicine; D013997:Time Factors
chemical_list: D000925:Anticoagulants