Structure and function of anticoagulation clinics in the United States: an AC forum membership survey

  • Geoffrey D. Barnes
  • Eva Kline-Rogers
  • Christopher Graves
  • Eric Puroll
  • Xiaokui Gu
  • Kevin Townsend
  • Ellen McMahon
  • Terri Craig
  • James B. Froehlich
Article
  • 109 Downloads

Abstract

Many anticoagulation clinics have adapted their services to provide care for patients taking direct oral anticoagulants (DOAC) in addition to traditional warfarin management. Anticoagulation clinic scope of service and operations in this transitional environment have not been well described in the literature. A survey was conducted of United States-based Anticoagulation Forum members to inquire about anticoagulation clinic structure, function, and services provided. Survey responses are reported using summary or non-parametric statistics, when appropriate. Unique clinic survey responses were received from 159 anticoagulation clinics. Clinic structure and staffing are highly variable, with approximately half of clinics (52%) providing DOAC-focused care in addition to traditional warfarin-focused care. Of those clinics managing DOAC patients, this accounts for only 10% of their clinic volume. These clinics commonly have a DOAC follow up protocol (75%). Clinics assign a median of 190.5 (interquartile range 50–300) patients per staff full-time-equivalent, with more patients assigned in phone-based care clinics than in face-to-face based care clinics. Most clinics (68.5%) report receiving reimbursement, which occur either through a combination of patient and insurance provider billing (78.2%), insurance reimbursement only (19.5%) or patient reimbursement only (2.3%). There is wide heterogeneity in anticoagulation clinic structure, function, and services provided. Half of all survey-responding anticoagulation clinics provide care for DOAC-treated patients. Understanding how changes in healthcare policy and reimbursement have impacted these clinics remains to be explored.

Notes

Compliance with ethical standards

Conflict of interest

GDB has received consulting fees from Pfizer, Bristol-Myers Squibb, Janssen, and Portola along with research support from Pfizer, Bristol-Myers Squibb, and the National Heart, Lung, and Blood Institute. EKR has received consulting fees from the American College of Physicians. JBF has received consulting fees from Pfizer, Bristol-Myers Squibb, and Janssen along with research funding from Pfizer and Bristol-Myers Squibb.

Ethical approval

This project was reviewed and deemed exempt from regulation by the University of Michigan institutional review board (HUM00126169).

Informed Consent

Consent was implied when survey respondents elected to complete the survey.

Supplementary material

11239_2018_1652_MOESM1_ESM.docx (77 kb)
Supplementary material 1 (DOCX 76 KB)

References

  1. 1.
    Holbrook A, Schulman S, Witt DM et al (2012) Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 141:e152S–e184SCrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ansell JE, Hughes R (1996) Evolving models of warfarin management: anticoagulation clinics, patient self-monitoring, and patient self-management. Am Heart J 132:1095–1100CrossRefPubMedGoogle Scholar
  3. 3.
    Barnes GD, Nallamothu BK, Sales AE, Froehlich JB (2016) Reimagining anticoagulation clinics in the era of direct oral anticoagulants. Circ Cardiovasc Qual Outcomes 9:182–185CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Barnes GD, Gu X, Haymart B et al (2014) The Predictive ability of the CHADS2 and CHA2DS2-VASc scores for bleeding risk in atrial fibrillation: the MAQI(2) experience. Thromb Res 134:294–299CrossRefPubMedGoogle Scholar
  5. 5.
    Hale ZD, Kong X, Haymart B et al (2017) Prescribing trends of atrial fibrillation patients who switched from warfarin to a direct oral anticoagulant. J Thromb Thrombolysis 43:283–288CrossRefPubMedGoogle Scholar
  6. 6.
    Rudd KM, Dier JG (2010) Comparison of two different models of anticoagulation management services with usual medical care. Pharmacotherapy 30:330–338CrossRefPubMedGoogle Scholar
  7. 7.
    Garrison SR, Allan GM (2014) Do specialty anticoagulation clinics really outperform primary care at INR management? J Thromb Thrombolysis 38:420–421CrossRefPubMedGoogle Scholar
  8. 8.
    McGuinn TL, Scherr S (2014) Anticoagulation clinic versus a traditional warfarin management model. Nurse Pract 39:40–46CrossRefPubMedGoogle Scholar
  9. 9.
    Stoudenmire LG, DeRemer CE, Elewa H (2014) Telephone versus office-based management of warfarin: impact on international normalized ratios and outcomes. Int J Hematol 100:119–124CrossRefPubMedGoogle Scholar
  10. 10.
    Entezari-Maleki T, Dousti S, Hamishehkar H, Gholami K (2016) A systematic review on comparing 2 common models for management of warfarin therapy; pharmacist-led service versus usual medical care. J Clin Pharmacol 56:24–38CrossRefPubMedGoogle Scholar
  11. 11.
    Heidbuchel H, Verhamme P, Alings M et al (2015) Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 17:1467–1507CrossRefPubMedGoogle Scholar
  12. 12.
    Burnett AE, Mahan CE, Vazquez SR, Oertel LB, Garcia DA, Ansell J (2016) Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis 41:206–232CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Steinberg BA, Shrader P, Thomas L et al (2016) Off-label dosing of non-vitamin K antagonist oral anticoagulants and adverse outcomes: The ORBIT-AF II registry. J Am Coll Cardiol 68:2597–2604CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Geoffrey D. Barnes
    • 1
  • Eva Kline-Rogers
    • 1
  • Christopher Graves
    • 1
  • Eric Puroll
    • 1
  • Xiaokui Gu
    • 1
  • Kevin Townsend
    • 2
  • Ellen McMahon
    • 2
  • Terri Craig
    • 2
  • James B. Froehlich
    • 1
  1. 1.Michigan Clinical Outcomes Research and Reporting ProgramUniversity of MichiganArborUSA
  2. 2.PfizerUS Medical AffairsNew YorkUSA

Personalised recommendations