Michigan Clinical Outcomes Research and Reporting Program, University of Michigan, Arbor, MI, USA.
Pfizer, US Medical Affairs, New York, NY, USA.
J Thromb Thrombolysis. 2018 Jul;46(1):7-11. doi: 10.1007/s11239-018-1652-z.
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.
许多抗凝诊所已经调整了其服务范围,除了传统的华法林管理之外,还为服用直接口服抗凝剂(DOAC)的患者提供护理。在这种过渡环境下,抗凝诊所的服务范围和运营情况在文献中并未得到很好的描述。我们对美国抗凝论坛的成员进行了一项调查,询问他们抗凝诊所的结构、功能和提供的服务。调查结果以摘要或非参数统计数据报告,在适当的情况下。我们收到了来自 159 家抗凝诊所的独特诊所调查回复。诊所的结构和人员配备差异很大,大约一半的诊所(52%)除了传统的华法林重点护理外,还提供 DOAC 重点护理。在管理 DOAC 患者的诊所中,这仅占其诊所工作量的 10%。这些诊所通常有 DOAC 随访方案(75%)。诊所平均为每位全职员工分配 190.5 名患者(中位数范围 50-300),基于电话的护理诊所比面对面的护理诊所分配的患者更多。大多数诊所(68.5%)报告收到报销,这些报销通过患者和保险提供者的联合计费(78.2%)、仅保险报销(19.5%)或仅患者报销(2.3%)的方式进行。抗凝诊所的结构、功能和提供的服务存在很大的异质性。所有接受调查的抗凝诊所中有一半为接受 DOAC 治疗的患者提供护理。了解医疗政策和报销的变化如何影响这些诊所仍然是一个待探索的问题。