| Warfarin is a drug with proven effectiveness in the prevention of stroke. Patients on warfarin need their therapy to be monitored by regular blood tests to prevent the occurrence of thrombotic and haemorrhagic events. Traditionally, this anticogulation service has been provided in secondary care anticoagulation clinics. The National Service Framework (NSF) for Older People (Department of Health 2001a) prioritised reduction in the incidence of stroke, this coupled with the UK's ageing population, has resulted in an expected 10% yearly increase in the demand for anticoagulation services. Current evidence suggests that not all patients who would benefit from warfarin are receiving it and, despite this unmet need, the pressure on the traditional hospital-based sen/ice is already becoming unsustainable.;The findings included equivalent anticoagulation control achieved by the domiciliary/ services compared to that achieved by the traditional hospital-based service. The number of adverse events in the domiciliary services was comparable to that observed in the traditional service. Finally, there was a significant improvement in patient satisfaction with the domiciliary services compared to the traditional service. The results suggest that the evidence based domiciliary anticoagulation service models were suitable alternatives to the traditional anticoagulation service model.;In this study, anticoagulation services at Barts and The London NHS Trust were to be developed and evaluated from a research perspective. Developmental work involved collection and analysis of patient satisfaction data, literature review and multidisciplinary discussions. Evidence from the developmental phase was triangulated and used to develop an intervention study to test the impact of providing anticoagulation services in patients' homes. The intervention was tested in a randomised crossover study comparing two models of domiciliary anticoagulation service for mobility-impaired patients with each other and against the traditional service provision. The first model involved a general phlebotomist obtaining venous samples in the patients' homes. All other aspects of the service were provided by the hospital. In the second model, one-stop testing and dosing in the patients' homes was performed by a trained pharmacist using near patient testing and software-assisted warfarin dosing. The domiciliary models were evaluated in terms of patient satisfaction, anticoagulation control and safety. |
