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Anticoagulation therapy and primary care internal medicine

A nurse practitioner model for combined clinical service

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Abstract

The anticoagulation clinics at the University of Virginia Health Sciences Center and the University of California at Davis Medical Center are nurse-practitioner-operated, are affiliated with the general medicine clinic, and rely on portable prothrombin time (PT) monitors that use whole blood and provide timely as well as accurate results reported in PT seconds or as the international normalized ratio (INR). On-site PT/INR testing at these clinics simplifies anticoagulation, mandates direct patient contact, and facilitates primary as well as comprehensive care for patients requiring multispecialty services in large tertiary care centers. Encounters are relatively brief, averaging 19 minutes; 72% of the encounter time involves anticoagulation care and 28% involves primary care. Anticoagulation results using portable PT/INR monitors are safe and accurate based on comparisons with results from clinics relying on standard instruments.

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References

  1. Dalen JE, Hirsh J (eds). Third ACCP Consensus Conference on Antithrombotic Therapy. Chest. 1992;102(suppl):303S–549S.

  2. David FB, Estruch MT, Samson-Corvera EB, Voight GC, Tobin JD. Management of anticoagulation in outpatients. Experience with an anticoagulation service in a municipal hospital setting. Arch Intern Med. 1977;137:197–202.

    Article  Google Scholar 

  3. Errichetti AM, Holden A, Ansell J. Management of oral anticoagulant therapy. Experience with an anticoagulation clinic. Arch Intern Med. 1984;144:1966–8.

    Article  PubMed  CAS  Google Scholar 

  4. Bussey HI, Rospond RM, Quandt CM, Clark GM. The safety and effectiveness of long-term warfarin therapy in an anticoagulation clinic. Pharmacotherapy. 1989;9:214–9.

    PubMed  CAS  Google Scholar 

  5. Cohen IA, Hutchinson TA, Kirking DM, Shue ME. Evaluation of pharmacist-managed anticoagulation clinic. J Clin Hosp Pharm. 1985;10:167–75.

    PubMed  CAS  Google Scholar 

  6. McCurdy SA, White RH. Accuracy and precision of a portable anticoagulation monitor in a clinical setting. Arch Intern Med. 1992;152:589–92.

    Article  PubMed  CAS  Google Scholar 

  7. Becker DM, Humphries JE, Walker FB, DeMong LK, Bopp JS, Acker MN. Standardizing the prothrombin time: calibrating coagulation instruments as well as thromboplastin. Arch Pathol Lab Med. 1993;117:602–5.

    PubMed  CAS  Google Scholar 

  8. White RH, Becker DM, Gunther-Maher MG. Experience using a portable monitor to monitor anticoagulant therapy. South Med J. 1994;87:206–10.

    Article  PubMed  CAS  Google Scholar 

  9. Fihn SD, McDonell M, Martin D, et al. Risk factors for complications of chronic anticoagulation—a multicenter study. Ann Intern Med. 1993;118:511–20.

    PubMed  CAS  Google Scholar 

  10. Fihn SD, McDonell MB, Vermes D, et al. A computerized intervention to improve timing of outpatient follow-up—a multicenter randomized trial in patients treated with warfarin. J Gen Intern Med. 1994;9:131–9.

    PubMed  CAS  Google Scholar 

  11. Hirsh J. Standard monitoring of warfarin in North America: time for a change. Arch Intern Med. 1992;152:257–8.

    Article  PubMed  CAS  Google Scholar 

  12. Gray DR, Garabedian-Ruffalo SM, Chretien SD. Cost justification of a clinical pharmacist-managed anticoagulation clinic. Drug Intel Clin Pharm. 1985;19:575–80.

    CAS  Google Scholar 

  13. Bussey HI, Rospond RM, Quandt CM, Clark GM. The safety and effectiveness of long-term warfarin therapy in an anticoagulation clinic. Pharmacotherapy. 189;9:214–19.

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Supported in part by VA grants IIR 87-063 and IIR 90-036.

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Becker, D.M., DeMong, L.K., Kaplan, P. et al. Anticoagulation therapy and primary care internal medicine. J Gen Intern Med 9, 525–527 (1994). https://doi.org/10.1007/BF02599227

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