Anticoagulation Management: A New Approach

Abstract

Anticoagulation therapy has been identified as an area in which new approaches to treatment and monitoring may allow for significant improvements in healthcare quality and costs. We evaluated the potential benefits of a new approach to anticoagulation therapy, utilizing decision support software, point-of-service testing, and workflow redesign. We performed an intervention study in the setting of a university-affiliated primary care clinic, involving 40 patients receiving chronic anticoagulation therapy. Study measurement included anticoagulation control, complications of therapy and related costs, as well as clinic revenue and overhead costs. After implementation of the new approach, the frequency of international normalized ratio (INR) results within therapeutic range increased from 34% to 67%. During a 1-year follow-up period, complications related to anticoagulation therapy were reduced by 91% (p < 0.01). Labor-related overhead costs decreased from approximately 12,600 to 3,100 US dollars. During the same period, the clinic generated approximately 35,000 US dollars in new revenue. For every dollar spent on clinic implementation and maintenance, over 25 US dollars was returned from cost containment and new revenue production. This approach allows a clinic to show improved anticoagulation control and complication rates while simultaneously improving financial performance.

Home Management of Oral Anticoagulation via Telemedicine Versus Conventional Hospital-Based Treatment

“…The patient is contacted, usually by writing and in some cases by phone, and is given the instructions for drug intake and next date of measurement. 1 This is traditionally managed in a paper record system.…”

How much does international normalized ratio monitoring cost during oral anticoagulation with a vitamin K antagonist? A systematic review

“…The cost of one INR test in 2006 ranged from US$6.19 of revenue for point‐of‐care testing (POCT) in a primary care clinic (Wurster & Doran, 2006) to $145.70 for a home visit plus laboratory test (Björholt et al. , 2007) (Table 1).…”

The impact of non‐vitamin K antagonist oral anticoagulants (NOACs) on anticoagulation therapy in rural Australia

“…44 Four of the RCTs investigated PoCT with another intervention. 8,18,21,34,58,59 The geographical setting included the United Kingdom (n=13) 8,16,18,21,33,[60][61][62][63][64][65][66][67] , Australia (n=7) 17,23,47,[68][69][70][71] , USA (n=5) 44,58,[72][73][74] , Belgium (n=2) 34,59 , Sweden (n=1) 75 and Ireland (n=1). 76 A description of the 29 studies included in the review is reported in Table 13 and Table 14.…”

“…Three undertook a cost-effectiveness analysis (two from a health care provider perspective 21,59 and one from a patient perspective 67 ); two reported the practice costs incurred 64,73 and one study 62 reported costs of the device and test. Claes et al 59 found that PoCT provided net savings for the health care provider while Parry et al 21 found PoCT costs to be greater than usual care to the health care provider.…”

“…Claes et al 59 found that PoCT provided net savings for the health care provider while Parry et al 21 found PoCT costs to be greater than usual care to the health care provider. One study 67 found PoCT to provide lower patient costs, two studies 64,73 which determined practice costs found PoCT to be cheaper and the one study 62 investigating PoCT device and test costs found that these varied depending on the device. Eight studies investigated patient satisfaction and acceptability of PoCT.…”