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

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.

Barriers to integrating direct oral anticoagulants into anticoagulation clinic care: A mixed‐methods study

“…The first theme to emerge from the interviews was that most providers were unaware of the services provided by the anticoagulation clinic for DOAC patients or the benefits of referral to the anticoagulation clinic (Table ). From the survey data, 83 of 159 (52.2%) of respondents indicated that their anticoagulation clinic provides care for DOAC patients, but the median estimated percent of their clinic made up of DOAC patients was 10% (IQR 5%‐30%) . There was no association between a clinic offering DOAC care and the clinic size (OR 1.013, 95% CI 0.993‐1.034, P = 0.191 for every 100 patients managed in the clinic).…”

“…The quantitative data was collected via an online survey of anticoagulation clinic providers (Online Appendix). Details have been published previously . Briefly, we invited all active members of the Anticoagulation Forum (a large peer organization of anticoagulation service providers in North America) to participate in an online survey.…”

The future of anticoagulation management services: Ensuring and expanding patient access to pharmacists' care

“…A recent survey of anticoagulation clinics registered with the Anticoagulation Forum found that 90% of the patients being managed within AMS models were being managed for warfarin use. Although 50% of clinics surveyed reported incorporation of DOACs into their service, only 10% of patients managed are DOAC users, creating a gap between use and management services . While patients receiving DOACs do not require routine laboratory monitoring, they are still at high risk of drug‐related adverse events .…”

“…In a recent survey of AMS registered with the Anticoagulation Forum, nearly 50% of clinics reported operating with a mixture of personnel (pharmacists, nurses, medical assistants, physician assistants). Approximately 70% of those clinics report utilizing pharmacists . Data derived from AMS evaluation primarily involve warfarin management.…”

“…Approximately 70% of those clinics report utilizing pharmacists. 3 Data derived from AMS evaluation primarily involve warfarin management. The most effective AMS model and ideal provider of anticoagulation management services is a subject of interest and investigation.…”