A. Davies et al., Anti-coagulant monitoring service delivery: a comparison of costs of hospital and community outreach clinics, CLIN LAB H, 22(1), 2000, pp. 33-40
Anti-coagulated patients are monitored at regular intervals to ensure that
their warfarin dosage is appropriate for their target International Normali
zed Ratio. The traditional setting for this monitoring has been the hospita
l clinic. Technological advances allow and with growing numbers of anti-coa
gulated patients, are leading to - greater provision of monitoring clinics
outside the hospital, at a more convenient location nearer patients' homes.
This paper discusses the differences in organization between a hospital cl
inic and one set in the community (although provided by the hospital), and
compares their costs. The comparison demonstrates the greater average cost
per appointment in outreach of pound 13.12 under current arrangements. Esti
mates are presented of incremental cost per appointment of pound 3.93 and p
ound 15.88 for a 10% increase in weekly patient numbers put through hospita
l and outreach clinics, respectively. Cost estimates are also presented for
suggested alterations to hospital clinics that may reduce patient inconven
ience, and the conditions under which outreach provision might be expanded
at comparable cost to hospital provision are also examined.