COSTS AND EFFECTIVENESS OF A NURSE SPECIALIST ANTICOAGULANT SERVICE

Aims-To determine the costs and effectiveness of an anticoagulant nurs e specialist service compared with a conventional consultant service b ased on two hospital sites in northwest Hertfordshire. Methods-Sequent ial design comparing retrospectively the conduct and outcomes of a con sultant service with a nurse specialist service over two six month per iods. In each of the six month study periods, all new patients consecu tively referred for anticoagulation over a three month period (group A ) at the start of each study period and a random selection of patients who had already been attending the anticoagulant service for one year or more (group B) were included in the study. Group A patients were f ollowed for up to three months and group B patients for six months. Th e main outcome measures were costs of service provision and effectiven ess. Costs included those far the use of the anticoagulant service, th ose related to general practitioner (GP) visits and hospitalisations, and running costs (staff time, laboratory tests, patient transport). M easures of effectiveness were the mean proportion of time patients spe nd in the therapeutic range, the number of drugs being taken that coul d interact adversely and/or inhibit haemostatic function, and patient and GP satisfaction with service provision. Results-In the consultant service, for group A there were more patients aged 66-75 years (p = 0. 004) and fewer patients aged more than 76 years (p = 0.001); and for g roup B, there were fewer patients on anticoagulation for cardiac condi tions (p = 0.001), but more on anticoagulation for thromboembolic cond itions (p = 0.02) than in the nurse specialist service. The clinic run ning costs of the nurse specialist service were pound 4.99 per attenda nce, compared with pound 4.75 in the consultant service. Including all other costs related to treatment, there was no statistically signific ant difference in cost per patient. There was no significant differenc e is the proportion of time patients spent in the therapeutic range be tween the consultant service and the nurse specialist service. In the nurse specialist service, fewer patients in group A were taking drugs that could interact adversely and/or inhibit haemostatic function (p = 0.01) and more patients were satisfied with service provision (p = 0. 04) compared with the consultant service. There was no significant var iation in GP satisfaction between the two services. Conclusion-In the provision of outpatient anticoagulation, the nurse specialist service was no more expensive than the consultant service and, using our prima ry outcome, at least as effective. The nurse specialist service has so me clear advantages compared to the consultant service: provision of d omicilliary care for house-bound patients, fewer new patients taking d rugs that could interact adversely and/or inhibit haemostatic function patients, it is preferred by newly referred patients to the consultan t service, and it is as acceptable to their GPs.