Consensus guidelines for coordinated outpatient oral anticoagulation therapy management. Anticoagulation Guidelines Task Force

OBJECTIVE: To provide primary and referring healthcare practitioners with guidelines for the provision of safe and effective anticoagulation management in any venue to standardize and improve quality of care and to permit negotiation for reimbursement from third-party payers. DATA EXTRACTION AND SYNTHESIS: Data on the current practice of anticoagulation providers and outcomes related to anticoagulation clinic care were obtained through the literature, interviews with anticoagulation providers, and a focus group meeting of anticoagulation clinic stakeholders. This information collation process revealed that an anticoagulation service consists of three separate areas for which guidelines should be developed. Based on the consensus opinions of the committee members, the literature review, and the current practice of anticoagulation services providers, a draft guideline was developed and reviewed by an independent multidisciplinary panel of anticoagulation services providers whose comments were incorporated into the final guideline. CONCLUSIONS: Systematic outpatient anticoagulation services are systems of care designed to coordinate and optimize the delivery of anticoagulation therapy by (1) evaluating patient-specific risks and benefits to determine the appropriateness of therapy; (2) facilitating the management of anticoagulation dosages and prescription pick up or delivery; (3) providing ongoing education of the patient and other caregivers about warfarin and the importance of self-care behavior leading to optimal outcomes; (4) providing continuous systematic monitoring of patients, international normalized ratio results, diet, concomitant drug therapy, and disease states; and (5) communicating with other healthcare practitioners involved in the care of the patient. To create a reproducible framework for the provision of these services, guidelines for structure, process, and outcomes of coordinated outpatient anticoagulation management services were developed. Guidelines for organization and management include (1) qualifications for personnel, (2) supervision, (3) care management and coordination, (4) communication and documentation, and (5) laboratory monitoring. Guidelines for the process of patient care include (6) patient selection and assessment, (7) initiation of therapy, (8) maintenance and management of therapy, (9) patient education, and (10) management and triage of therapy-related and unrelated problems. Guidelines for the evaluation of patient outcomes include (11) organizational components and (12) patient outcomes. The impact of these 12 guidelines on patient care and reimbursement procurement will depend on their implementation and the perceived value of their use.

This article has been cited by other articles:

				S. H. Hohnloser, G. Z. Duray, U. Baber, and J. L. Halperin Prevention of stroke in patients with atrial fibrillation: current strategies and future directions Eur. Heart J. Suppl., September 1, 2008; 10(suppl_H): H4 - H10. [Abstract] [Full Text] [PDF]

				J. Ansell, J. Hirsh, E. Hylek, A. Jacobson, M. Crowther, and G. Palareti Pharmacology and Management of the Vitamin K Antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 160S - 198S. [Abstract] [Full Text] [PDF]

				C. L Garwood and T. L Corbett Use of Anticoagulation in Elderly Patients with Atrial Fibrillation Who Are at Risk for Falls Ann. Pharmacother., April 1, 2008; 42(4): 523 - 532. [Abstract] [Full Text] [PDF]

				A. K. Wittkowsky, E. A. Nutescu, J. Blackburn, J. Mullins, J. Hardman, J. Mitchell, and V. Vats Outcomes of Oral Anticoagulant Therapy Managed by Telephone vs In-Office Visits in an Anticoagulation Clinic Setting. Chest, November 1, 2006; 130(5): 1385 - 1389. [Abstract] [Full Text] [PDF]

				A. G. Staresinic, C. A. Sorkness, B. M. Goodman, and D. W. Pigarelli Comparison of outcomes using 2 delivery models of anticoagulation care. Arch Intern Med, May 8, 2006; 166(9): 997 - 1002. [Abstract] [Full Text] [PDF]

				P. S.J. Miller, M. F. Drummond, L. K. Langkilde, J. J.V. McMurray, and M. Ogren Economic factors associated with antithrombotic treatments for stroke prevention in patients with atrial fibrillation Eur. Heart J. Suppl., May 1, 2005; 7(suppl_C): C41 - C54. [Abstract] [Full Text] [PDF]

				M. A. Smythe, W. E. Dager, and N. M. Patel Managing Complications of Anticoagulant Therapy Journal of Pharmacy Practice, October 1, 2004; 17(5): 327 - 346. [Abstract] [PDF]

				J. Ansell, J. Hirsh, L. Poller, H. Bussey, A. Jacobson, and E. Hylek The Pharmacology and Management of the Vitamin K Antagonists: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 204S - 233S. [Abstract] [Full Text] [PDF]

				A. S. Go, E. M. Hylek, Y. Chang, K. A. Phillips, L. E. Henault, A. M. Capra, N. G. Jensvold, J. V. Selby, and D. E. Singer Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation: How Well Do Randomized Trials Translate Into Clinical Practice? JAMA, November 26, 2003; 290(20): 2685 - 2692. [Abstract] [Full Text] [PDF]

				D. E. Singer A 60-Year-Old Woman With Atrial Fibrillation JAMA, October 22, 2003; 290(16): 2182 - 2189. [Full Text] [PDF]

				S. J.-A. Wilson, P. S. Wells, M. J. Kovacs, G. M. Lewis, J. Martin, E. Burton, and D. R. Anderson Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: a randomized controlled trial Can. Med. Assoc. J., August 19, 2003; 169(4): 293 - 298. [Abstract] [Full Text] [PDF]

				S. Nadar, N. Begum, B. Kaur, S. Sandhu, and G. Y H Lip Patients' understanding of anticoagulant therapy in a multiethnic population J R Soc Med, April 1, 2003; 96(4): 175 - 179. [Abstract] [Full Text] [PDF]

				S. E. Straus, S. R. Majumdar, and F. A. McAlister New Evidence for Stroke Prevention: Clinical Applications JAMA, September 18, 2002; 288(11): 1396 - 1398. [Abstract] [Full Text] [PDF]

				J. H. Gurwitz and P. Rochon Improving the Quality of Medication Use in Elderly Patients: A Not-So-Simple Prescription Arch Intern Med, August 12, 2002; 162(15): 1670 - 1672. [Full Text] [PDF]

				D. McCormick, J. H. Gurwitz, R. J. Goldberg, R. Becker, J. P. Tate, A. Elwell, and M. J. Radford Prevalence and Quality of Warfarin Use for Patients With Atrial Fibrillation in the Long-term Care Setting Arch Intern Med, November 12, 2001; 161(20): 2458 - 2463. [Abstract] [Full Text] [PDF]

				A. J. Cohen, A. Tamir, S. Houri, B. Abegaz, E. Gilad, S. Omohkdion, D. Zabeeda, V. Khazin, A. Ciubotaru, and A. Schachner Save a child's heart: we can and we should Ann. Thorac. Surg., February 1, 2001; 71(2): 462 - 468. [Abstract] [Full Text] [PDF]

				R. G. Holloway, C. Benesch, and S. R. Rush Stroke prevention: Narrowing the evidence-practice gap Neurology, May 23, 2000; 54(10): 1899 - 1906. [Abstract] [Full Text] [PDF]

				G. P. Samsa, D. B. Matchar, L. B. Goldstein, A. J. Bonito, L. J. Lux, D. M. Witter, and J. Bian Quality of Anticoagulation Management Among Patients With Atrial Fibrillation: Results of a Review of Medical Records From 2 Communities Arch Intern Med, April 10, 2000; 160(7): 967 - 973. [Abstract] [Full Text] [PDF]