Clinical studyImproving the quality of anticoagulation of patients with atrial fibrillation in managed care organizations: results of the managing anticoagulation services trial☆
Section snippets
Design
To identify sites, we obtained a list of managed care organizations with Medicare managed care contracts from the Health Care Financing Administration. Thirty-five of the larger managed care organizations were contacted. We selected six organizations, including four that contracted with independent practices, one that had a staff model organization, and one that incorporated both organizational structures. At each site, two geographically related groups of practices with approximately 200 to
Results
An anticoagulation service meeting the functional specifications for the trial was set up at all six sites. One site was subsequently dropped from the study for failing to meet minimum performance requirements. The remaining five sites enrolled eligible patients throughout the trial, with final enrollments ranging from 70 to 200 patients per clinic. Based on data from the managed care organization administrative files and clinic enrollment lists, the percentage of eligible providers who used
Discussion
We determined that developing an anticoagulation service in a managed care environment was feasible—five of the six sites were able to implement an anticoagulation service consistent with the standard specifications for anticoagulation care. Our results indicate that a properly administered anticoagulation service can successfully manage the anticoagulation of most patients with atrial fibrillation; however, these services did not improve anticoagulation compared with usual care.
The success of
Acknowledgements
We would like to thank Kenneth Goldberg, MD, for programming assistance; Meg McCormack, PA-C, RN, for her work in helping to identify sites and in monitoring the operations of the anticoagulation services; Olivier Rutschmann, MD, MPH, for assistance in the analysis of event data; William Rock, PharmD, for providing the training to the site anticoagulation clinic managers; and Yen-Pin Chiang, PhD, of the Agency for Healthcare Research and Quality and Kim Gilchrist, MD, of DuPont Pharmaceuticals
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2021, Research in Social and Administrative PharmacyCitation Excerpt :Conversely, if anticoagulation intensity is too high, the patient is at an increased risk of hemorrhage.7 However, anticoagulation control is often suboptimal, despite the potential for negative health consequences.8 Proper education for patients receiving anticoagulation therapy is vital.
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This study was supported by Contract 290-91-0028 from the Agency for Healthcare Research and Quality, and DuPont Pharmaceuticals Company, Wilmington, Delaware.