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Nurse-coordinated anticoagulation clinic
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Hospital specialist
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Nurse specialist
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• Nurses well placed to coordinate contact with patients, the initial prescriber and other HCPs
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• Requires well-educated expert nurses and resources for an anticoagulation clinic
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• Determination of individual patient visit schedules
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• Nurses can take a holistic view (co-morbidities), make a full assessment and educate the patient
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• Medico-legal liability issues
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• Easy-to-manage patients could have primary contact through the GP; clinic could function as a coordinator and remote evaluator of care
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• Less intensive for the specialist, allowing them to focus fully on the treatment plan
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• Non-medical as well as medical aspects and patient preference to be taken into account when considering whether to switch from VKA to NOAC
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Nurse-assisted anticoagulation clinic
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Hospital specialist
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Cardiologist/haematologist, assisted by nurse
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• Nurse does not require extensive anticoagulation expertise but can still organise patient visits and provide basic checks and education
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• Resource- and time-heavy for specialist
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• As above
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GP coordinated, without anticoagulation clinic
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Hospital specialist or specialist GP
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GP
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• Reduces pressure on hospital resources
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• Increased pressure on GP resources
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• GPs to maintain contact with patients at a frequency based on patient risks and preferences
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• GPs generally know their patients well
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• GPs must be well trained in anticoagulation (NOACs as well as VKAs)
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• Specialist department to be available to evaluate the patient at the GP’s request
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• Can perform home visits
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• Good relationship/network needed between hospital departments and local community physicians
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• GP may rely on the specialist for his/her own education – only well-educated GPs should be prescribers of NOACs
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